autologous blood and marrow transplantation - Blog Science ...

Adult ALL: BMT in First Remission for Selected Patients
Dieter Hoelzer, Nicola Gokbuget
University Hospital, J.W. Goethe University, Frankfurt, Germany
INTRODUCTION
One of the major areas of discussion in the treatment of adult acute
lymphoblastic leukemia (ALL) is which patient should be treated with
chemotherapy only and which should receive stem cell transplantation in addition.
In relapsed and refractory adult ALL patients, bone marrow transplantation (BMT)
in second or subsequent clinical remission (CR) is undoubtedly the treatment of
first choice. There is, however, an ongoing debate whether BMT should be offered
to all adult ALL patients in first remission (CR1) or whether it should be restricted
to selected subgroups. In adult ALL, survival after chemotherapy in first remission
is approximately 35%, with a wide range of 10 to >50% for specific subgroups. For
subgroups such as T-ALL and B-ALL (T and B cell ALL), considerable progress
has been achieved, with survival rates of approximately >50% with optimization of
chemotherapy. Whereas in other subgroups such as high-risk B-lineage ALL, and
particularly in Ph/bcr-aW-positive (Ph +
) ALL, no improvement has occurred and
survival is still