Submitted October 16, 2008
Accepted January 17, 2009
Prolonged survival in adults with acute lymphoblastic leukemia (ALL) following reduced intensity conditioning with cord blood or sibling donor transplantation
Veronika Bachanova*, Michael R. Verneris, Todd DeFor, Claudio G. Brunstein, and Daniel J. Weisdorf
Blood and Marrow, Transplant Program, University of Minnesota, Minneapolis, MN, United States
* Corresponding author; email: bach0173{at}umn.edu.
Twenty-two adult ALL patients (21/22 in complete remission [CR]) received reduced intensity conditioning (RIC) followed by allogeneic transplantation. All patients were high risk. Following a uniform preparative regimen (fludarabine 40 mg/m2 x 5, cyclophosphamide 50 mg/kg, 200 cGy total body irradiation) patients received either matched related (n=4) or umbilical cord (n=18) donor grafts. All patients reached neutrophil engraftment and 100% donor chimerism (median days 10 and 23). Overall survival, treatment related mortality and relapse were 50% (95% CI: 27-73%), 27% (95% CI: 9-45%), 36% (95% CI: 14-58%) at 3 years, respectively. There were no relapses beyond 2 years. The cumulative incidence of acute and chronic graft versus host disease was 55% and 45%. HCT in CR1 (n=14) led to significantly less TRM (8%, p<0.04) and improved OS (81%, p<0.01). For adults with ALL in CR, RIC allografting results in modest TRM, limited risk of relapse and promising leukemia-free survival. Clinical trial numbers are NCT00365287, NCT00305682 and NCT00303719.
