Allogeneic Hematopoietic Stem Cell Transplantation in Adult Acute Lymphocytic Leukemia: Impact of Donor Source on Survival

摘要: Abstract We studied the relative impact of donor source on outcomes following myeloablative hematopoietic stem cell transplantation (HSCT) for adult patients with acute lymphocytic leukemia (ALL). In this single center study, 138 patients aged 18-61 (median 31) years underwent conditioning followed by allogeneic HSCT. Stem was an HLA matched related (MRD) in 90, unrelated (URD:M) 15, mismatched (URD:MM) 14, and 0-2 (A, B, DRB1) umbilical cord blood (UCB) 19 patients. At time HSCT, 70 were first clinical remission (CR1), 57 CR2, 11 ≥CR3. Twenty-one had T-lineage disease; 43 (31%) high-risk cytogenetics either t(9;22) (n = 33), t(4;11) or t(1,19) abnormalities, remainder (69%) having normal cytogenetics. White count (WBC) ≥30 × 10 9 /L at diagnosis documented 33%. Demographics disease characteristics similar all 4 groups except UCB recipients treated since 1996 received growth factors. Overall survival (OS) 3 group 66% (95% confidence interval [CI] 44%-89%) compared to 27% CI 17%-36%) MRD group, only 13% 0%-31%) 14% 0%-33%) URD:M URD:MM groups, respectively. Similarly free (LFS) better 61% 38%-84%) than 18%-36%) (95%CI group. Relapse rates 3 years 5% 0%-15%) 26% 16%-35%) MRD, 20% 1%-39%) 0% groups. Transplant-related mortality (TRM) lowest 34% higher other groups: 47%, 67%, 86%. multiple regression analysis, 5 independent risk factors significantly associated poorer OS LFS: use (relative [RR] 2.5, 95% CI, 1.2-5.1, P .01), ≥CR3 HSCT (RR 3.5, 1.2-9.6, .02), WBC /l 1.9, 1.2-3.0, .01) diagnosis, recipient (R/D) cytomegalovirus (CMV) seropositive 3.8, 2.0-7.4, .02). Graft-versus-host (GVHD) improved LFS 0.4, 0.2-0.6,  = supporting as alternative adults ALL.