autologous blood and marrow transplantation - Blog Science ...

58 Chapter 2: ALL
Table 1. Comparison of disease-free survival in alloBMT and chemotherapy for AML
and ALL
Allogeneic BMT
CR1 (%) CR2 (early first relapse) (%) >CR2(%)
AML 40-65 15-40 5-20
ALL 40-65 2540 10-20
Chemotherapy
AML 20-40 0-5 0
ALL 20-40 0-5 0
Several studies have been reported on patients with ALL who are beyond first
remission or in relapse. 23
Over the past decade, several studies have reported on
allogeneic bone marrow transplantation (alloBMT) in first remission, with the
cumulative data suggesting a disease-free survival of 40-65% and a relapse rate of
10-40%, mostly during the first 2 years. 14,5
A retrospective study from the International Bone Marrow Transplant Registry
(IBMTR) with selected published data of chemotherapy using matched patients
showed no significant difference between allogeneic transplants for patients in first
remission when compared with standard chemotherapy. Treatment-related
mortality was significantly higher in patients undergoing allotransplant but was
offset by a far greater relapse among those receiving chemotherapy. 6
Prognostic factors that impact favorably on the outcome of allogeneic transplantation
in ALL are first complete remission, low tumor burden, absence of resistant
disease, and the presence of mild (grade 1-2) posttransplant graft-vs.-host disease. 7
The majority of patients do not have a suitable HLA-compatible donor. While
recent reports on the use of allogeneic matched unrelated donors show promise,
such a procedure cannot be justified for ALL in first remission except for those
with the presence of the Philadelphia chromosome. For all other patients who do
not have a histocompatible sibling, the only transplant alternative to be considered
is autologous stem cell transplantation.
Unlike AML, the standard postremission therapy for ALL includes protracted
consolidation/maintenance chemotherapy for up to 2 years, and a single course of
autologous stem cell transplantation early in the course of disease may significantly
improve the quality of life of patients in first remission, even if the long-term
outcome is not superior to standard therapy but is at least as good. Obviously, the
ultimate aim would be to develop a stem cell regimen that would improve on
standard therapy, but the consideration for stem cell transplant must take into
account the difficult period that patients undergo during their protracted standard
therapy with chemotherapy.
In reviewing the data, rather surprisingly, a considerable number of autologous
transplants have been performed in ALL and there is no shortage of published