SEARCH:   Advanced

Blood, 15 July 2008, Vol. 112, No. 2, pp. 426-434. Prepublished online as a Blood First Edition Paper on April 8, 2008; DOI 10.1182/blood-2007-12-128918. This Article Full Text (PDF) All Versions of this Article: blood-2007-12-128918v1 112/2/426    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Marks, D. I. Articles by Weisdorf, D. J. Search for Related Content PubMed PubMed Citation Articles by Marks, D. I. Articles by Weisdorf, D. J. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted December 17, 2007 Accepted March 6, 2008 Unrelated donor transplants in adults with Philadelphia-negative acute lymphoblastic leukemia in first complete remission David I. Marks, Waleska S. Perez, Wensheng He, Mei-Jie Zhang, Michael R. Bishop, Brian J. Bolwell, Christopher N. Bredeson, Edward A. Copelan, Robert Peter Gale, Vikas Gupta, Gregory A. Hale, Luis M. Isola, Ann A. Jakubowski, Armand Keating, Thomas R. Klumpp, Hillard M. Lazarus, Jane L. Liesveld, Richard T. Maziarz, Philip L. McCarthy, Mitchell Sabloff, Gary Schiller, Jorge Sierra, Martin S. Tallman, Edmund K. Waller, Peter H. Wiernik, and Daniel J. Weisdorf* Adult BMT Unit, United Bristol Healthcare Trust, Bristol, United Kingdom Center for International BMT Research, Medical College of Wisconsin, Milwaukee, WI, United States Department of Experimental Transplantation/Immunology, National Cancer Institute, Bethesda, MD, United States Hematology/Oncology & Blood Disorders, Cleveland Clinic Foundation, Cleveland, OH, United States Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI, United States Oncology, Center for Advanced Studies in Leukemia, Los Angeles, CA, United States Medical Oncology/Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada Bone Marrow Transplantation, St. Jude Children's Research Hospital, Memphis, TN, United States Medicine, Mt. Sinai Hospital, New York, NY, United States Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Bone Marrow Transplantation, Fox Chase-Temple BMT Program, Philadelphia, PA, United States Adult BMT, University Hospitals of Cleveland, Cleveland, OH, United States Hematology/Oncology, University of Rochester Medical Center, Rochester, NY, United States Adult BMT, Oregon Health Sciences University, Portland, OR, United States Dept of Medicine, Roswell Park Cancer Institute, Buffalo, NY, United States Hematology, Ottawa Hospital, Ottawa, ON, Canada School of Medicine, University of California, Los Angeles, CA, United States Hematology, Hospital Santa Creu Sant Pau, Barcelona, Spain Medicine, Northwestern Memorial Hospital, Chicago, IL, United States Bone Marrow & Stem Cell Transplantation, Emory University Hospital, Atlanta, GA, United States Medicine, Our Lady of Mercy Medical Center, Bronx, NY, United States Hematology/Oncology, University of Minnesota, Minneapolis, MN, United States * Corresponding author; email: weisd001{at}umn.edu. We report the retrospective outcomes of unrelated donor (URD) transplants in 169 patients with acute lymphoblastic leukaemia (ALL) in first complete remission (CR1) transplanted between 1995-2004. Median age was 33 (16 - 59) years. 50% had a WBC >30 x 109/L, 18% extramedullary disease, 42% achieved CR >8 weeks from diagnosis, 25% had adverse cytogenetics and 19% T-cell leukemia. 41% were HLA-well-matched, 41% partially matched with their donors; 18% of patients were HLA-mismatched. At 54 months median follow-up, incidences of acute grade II-IV, III-IV and chronic GVHD were 50%, 25% and 43%. 5 year treatment-related mortality (TRM), relapse and overall survival were 42%, 20% and 39% respectively. In multivariate analyses, TRM was significantly higher with HLA-mismatched donors (RR=1.83, p=0.037) and T-depletion (TCD) (RR=2.67, p=0.002). Relapse risk was higher (RR=2.22, p=0.045) if the diagnostic WBC was >100 x 109/L. Factors associated with poorer survival included WBC >100 x 109/L (RR=1.80, p=0.014), >8 weeks to CR1 (RR=1.77, p=0.006), CMV seropositivity (RR=1.61, p=0.04), HLA-mismatching (RR=2.09, p=0.003) and TCD (RR=2.50, p=0.003). Nearly 40% of adults with ALL in CR1 survive 5 years after URD transplantation. Relapse risks were modest; TRM is the major cause of treatment failure. Selecting closely HLA-matched URD and reducing TRM should improve results. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: Allografting in ALL: the net widens Jacob M. Rowe Blood 2008 112: 212. [Full Text] [PDF] Response: Unrelated donor transplantation for adults with Ph– ALL in first complete remission David I. Marks, Daniel J. Weisdorf, and Mei-Jie Zhang Blood 2008 112: 448-449. [Full Text] [PDF] Hemoglobin normalization after splenectomy in a paroxysmal nocturnal hemoglobinuria patient treated by eculizumab Antonio M. Risitano, Ludovica Marando, Elisa Seneca, and Bruno Rotoli Blood 2008 112: 449-451. [Full Text] [PDF] This article has been cited by other articles: B. Patel, K. E. Kirkland, R. Szydlo, R. M. Pearce, R. E. Clark, C. Craddock, E. Liakopoulou, A. K. Fielding, S. Mackinnon, E. Olavarria, et al. Favorable outcomes with alemtuzumab-conditioned unrelated donor stem cell transplantation in adults with high-risk Philadelphia chromosome-negative acute lymphoblastic leukemia in first complete remission Haematologica, October 1, 2009; 94(10): 1399 - 1406. [Abstract] [Full Text] [PDF] M. B. Tomblyn, M. Arora, K. S. Baker, B. R. Blazar, C. G. Brunstein, L. J. Burns, T. E. DeFor, K. E. Dusenbery, D. S. Kaufman, J. H. Kersey, et al. Myeloablative Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia: Analysis of Graft Sources and Long-Term Outcome J. Clin. Oncol., August 1, 2009; 27(22): 3634 - 3641. [Abstract] [Full Text] [PDF] V. Bachanova, M. R. Verneris, T. DeFor, C. G. Brunstein, and D. J. Weisdorf Prolonged survival in adults with acute lymphoblastic leukemia after reduced-intensity conditioning with cord blood or sibling donor transplantation Blood, March 26, 2009; 113(13): 2902 - 2905. [Abstract] [Full Text] [PDF] J. Mehta Hematopoietic stem cell transplantation from unrelated donors for acute leukemia Blood, July 15, 2008; 112(2): 447 - 448. [Full Text] [PDF] D. I. Marks, D. J. Weisdorf, and M.-J. Zhang Response: Unrelated donor transplantation for adults with Ph- ALL in first complete remission Blood, July 15, 2008; 112(2): 448 - 449. [Full Text] [PDF]

	Copyright © 2008 by American Society of Hematology         Online ISSN: 1528-0020