Twenty Years’ Experience in Allogeneic Hematopoietic Stem Cell Transplantation for Philadelphia Chromosome—Positive Acute Lymphoblastic Leukemia in the Nagoya Blood and Marrow Transplantation Group

Abstract

Between October 1981 and December 2000, 46 patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) underwent allogeneic hematopoietic stem cell transplantation (HSCT) in the Nagoya Blood and Marrow Transplantation Group. The median age was 28.5 years (range, 4-51 years). All but one patient achieved engraftment. Grade II-to-IV acute graft-versus-host disease (GVHD) developed in 32.5% of patients, and chronic GVHD developed in 40.5%. The incidences of relapse and treatment-related mortality (TRM) at 5 years were 65% and 26%, respectively. The estimated overall survival rate at 5 years was 23%. Univariate analysis showed that improved disease-free survival (DFS) was independently associated with complete remission (CR) at transplantation (39%), compared with non-CR (8%) (P = .023). Non-CR at transplantation was associated with a higher risk of relapse. Donor type, acute GVHD, and time from diagnosis to HSCT all had a significant effect on TRM. In a multivariate analysis, 9 months or more from diagnosis to HSCT was the only variable statistically significant for DFS (relative risk, 3.22; P = .01). This study demonstrates that allogeneic HSCT cures a significant population of patients with Ph+ ALL. Relapse is the major obstacle limiting the success of HSCT. Early transplantation during CR from donors, including unrelated persons or mismatched relatives, may offer improved long-term DFS.

Myeloablative allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia in adults: significant roles of total body irradiation and chronic graft-versus-host disease

“…At present it is thought that allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative option for this disease. Several articles have dealt with the outcome for Ph þ ALL patients undergoing allo-HSCT, [10][11][12][13][14][15][16][17][18][19][20][21][22] but more detailed information is needed on a larger number of subjects. We therefore undertook a retrospective study involving 197 Ph þ ALL patients, using the registry data of the Japan Society of Hematopoietic Cell Transplantation (JSHCT).…”

Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study

“…Otherwise, disease-free survival (DFS) of these patients is only in the range of 10-40% even after allo-HSCT [4][5][6][7]. Relapse of underlying disease is still the obstacle for the success of this strategy.…”

The Negative Impact of Imatinib Mesylate Therapy Prior to Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Chronic Myeloid Leukemia

“…Severe (grades III and IV) acute GVHD is associated with poor outcome, while chronic extensive GVHD is associated with improved survival. 37,38 The outcome of allogeneic HSCT in CML patients is determined by the following: (1) recipient-related factors: age, comorbidity index, race, performance status, prior chemotherapeutic regimens, IL-10 promotor polymorphism, and disease status (stage, cytogenetic abnormalities and time from diagnosis). (2) donor-related factors: age, gender, KIR genotype and level of HLA mismatching.…”