TY - JOUR
T1 - Autologous versus allogeneic unrelated donor transplantation for acute lymphoblastic leukemia
T2 - Comparative toxicity and outcomes
AU - Weisdorf, Daniel
AU - Bishop, Michael
AU - Dharan, Bernie
AU - Bolwell, Brian
AU - Cahn, Jean Yves
AU - Cairo, Mitchell
AU - Giralt, Sergio
AU - Klein, John
AU - Lazarus, Hillard
AU - Litzow, Mark
AU - Marks, David
AU - McCarthy, Philip
AU - Miller, Carole
AU - Milone, Gustavo
AU - Russell, James
AU - Schultz, Kirk R.
AU - Sierra, Jorge
AU - Wiernik, Peter
AU - Keating, Armand
AU - Loberiza, Fausto
AU - Kollman, Craig
AU - Horowitz, Mary
PY - 2002
Y1 - 2002
N2 - For patients with high-risk or relapsed acute lymphoblastic leukemia (ALL) lacking a related histocompatible donor, autologous (Auto) and unrelated donor (URD) transplantation are available options. We compared outcomes and toxicities in 712 patients with ALL (517 URD, 195 Auto) in first complete remission (CR1) or second complete remission (CR2) who underwent transplantation. All patients were <50 years old, although URD patients were younger (median age, 14 versus 18 years, P < .002). The proportion of patients in CR1 versus CR2 was similar (36% versus 38%, P = .57), but more URD recipients than Auto recipients had high-risk karyotypes (25% versus 13%, P = .003) and white blood cell (WBC) counts ≥50 × 109/L (33% versus 14%, P < .001). Engraftment was similar in URD and Auto recipients. Ex vivo purging delayed but did not prevent engraftment after Auto transplantation. Transplantation-related mortality was higher after URD transplantation (42% ± 8%) than after Auto transplantation (20% ± 12%) in CR1 (P = .004) and also in CR2. Conversely, relapse was more frequent after Auto transplantation in CR1 (Auto, 49% ± 12% versus URD, 14% ± 5%) and CR2 (64% ± 8% versus 25% ± 5%) (P < .0001). These findings showed net similar outcomes for these 2 transplantation choices. Transplantation in CR1 yielded similar 3-year survival rates for URD (51% ± 7%) and Auto (44% ± 12%), as did transplantation in CR2 (40% ± 6% versus 32% ± 9%, respectively). Multivariate regression analysis identified significantly better disease-free survival after the first 6 months in matched URD versus Auto in younger patients, in those in CR2 with CR1 >1 year, WBC <50 × 109/L, performance status ≥90%, and in those who have undergone transplantation since 1995. These comparative data suggest that both matched URD and Auto transplantation can yield extended survival. Although URD transplantation offers substantially better protection against leukemic relapse, improvements in allotransplantation safety and refinements in patient selection are required to better aid treatment decision making for the best overall survival.
AB - For patients with high-risk or relapsed acute lymphoblastic leukemia (ALL) lacking a related histocompatible donor, autologous (Auto) and unrelated donor (URD) transplantation are available options. We compared outcomes and toxicities in 712 patients with ALL (517 URD, 195 Auto) in first complete remission (CR1) or second complete remission (CR2) who underwent transplantation. All patients were <50 years old, although URD patients were younger (median age, 14 versus 18 years, P < .002). The proportion of patients in CR1 versus CR2 was similar (36% versus 38%, P = .57), but more URD recipients than Auto recipients had high-risk karyotypes (25% versus 13%, P = .003) and white blood cell (WBC) counts ≥50 × 109/L (33% versus 14%, P < .001). Engraftment was similar in URD and Auto recipients. Ex vivo purging delayed but did not prevent engraftment after Auto transplantation. Transplantation-related mortality was higher after URD transplantation (42% ± 8%) than after Auto transplantation (20% ± 12%) in CR1 (P = .004) and also in CR2. Conversely, relapse was more frequent after Auto transplantation in CR1 (Auto, 49% ± 12% versus URD, 14% ± 5%) and CR2 (64% ± 8% versus 25% ± 5%) (P < .0001). These findings showed net similar outcomes for these 2 transplantation choices. Transplantation in CR1 yielded similar 3-year survival rates for URD (51% ± 7%) and Auto (44% ± 12%), as did transplantation in CR2 (40% ± 6% versus 32% ± 9%, respectively). Multivariate regression analysis identified significantly better disease-free survival after the first 6 months in matched URD versus Auto in younger patients, in those in CR2 with CR1 >1 year, WBC <50 × 109/L, performance status ≥90%, and in those who have undergone transplantation since 1995. These comparative data suggest that both matched URD and Auto transplantation can yield extended survival. Although URD transplantation offers substantially better protection against leukemic relapse, improvements in allotransplantation safety and refinements in patient selection are required to better aid treatment decision making for the best overall survival.
KW - Acute lymphoblastic leukemia
KW - Allogeneic unrelated
KW - Autologous
KW - Bone marrow transplantation
UR - http://www.scopus.com/inward/record.url?scp=0035999678&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035999678&partnerID=8YFLogxK
U2 - 10.1053/bbmt.2002.v8.pm12014810
DO - 10.1053/bbmt.2002.v8.pm12014810
M3 - Article
C2 - 12014810
AN - SCOPUS:0035999678
SN - 1083-8791
VL - 8
SP - 213
EP - 220
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 4
ER -