autologous blood and marrow transplantation - Blog Science ...

Sierra et al.
INTRODUCTION
Two-thirds of ALLs develop in children, a patient population where a
substantial improvement in prognosis has been achieved. 1
ALL represents 20% of
all adult leukemias, and the outcome in this setting is less encouraging. 23
Complete
remission (CR) rates range between 74 and 95% in a review including data from
10 studies. 4
Significant therapeutic advances have been made in specific immune
subtypes such as T-ALL and B-mature ALL and are the consequence of more
tailored intensive postremission chemotherapy. 4,5
Despite this, adult ALL is
curable in only 20-35% of all patients. 4
Since leukemia recurrence is the main
cause of treatment failure, high-dose therapy with hematopoietic rescue has been
performed in relatively young patients with the intention to eradicate the disease.
Allogeneic bone marrow transplantation probably improves the outcome of adult
ALL patients in first complete remission (CR1) with very high risk features at
diagnosis. 6,7
After relapse, adult ALL is unlikely to be cured with chemotherapy,
and SCT is usually indicated. Only 30% of patients who are candidates for highdose
therapy and SCT have an HLA-identical sibling. AutoSCT is the most
frequent option for the remaining 70% of cases. The role of this therapy in adult
ALL and the optimal conditions for the procedure (preparative regimen, source of
stem cells, need of purging to remove malignant cells from the graft) are not well
established.
We herein describe the 11 years' experience on 79 consecutive autoSCT for
adult ALL using a common protocol at two institutions in Barcelona. Special
emphasis is placed on the series of patients who received purged BM and the
factors that influenced the outcome of the procedure. A subset of the patients from
this study has been included in a previous report. 8
PATIENTS AND METHODS
Between October 1986 and November 1997, adult ALL patients in remission or
in early relapse, diagnosed at or referred to the Hospital de la Santa Creu I Sant Pau
or the Hospital Clinic from Barcelona, were considered for SCT. Allogeneic SCT
(alloSCT) was the first option if an HLA-identical sibling was available. The upper
age limit for this procedure increased over time from 45 to 60 years. Unrelated SCT
was performed only in very poor prognosis patients lacking a suitable relative if a
compatible nonfamily volunteer was identified on a short-term basis. Patients
without a donor for alloSCT and aged