INTENSIVE THERAPY FOLLOWED BY BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH ACUTE LYMPHOCYTIC-LEUKEMIA IN 2ND OR SUBSEQUENT REMISSION - DETERMINATION OF PROGNOSTIC FACTORS (A REPORT FROM THE UNIVERSITY-OF-MINNESOTA BONE-MARROW TRANSPLANTATION TEAM)

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  • 1 January 1983
    • journal article
    • research article
    • Vol. 61  (6) , 1182-1189
Abstract
Fifteen patients with acute lymphocytic leukemia (ALL) in 2nd or subsequent remission received intensive therapy with cyclophosphamide and single dose, rapid rate (26 cGy[centrigray]/min) total body irradiation (TBI) followed by bone marrow transplantation (BMT) from a histocompatible sibling matching. Outcome was compared to that of 23 conventionally treated control patients in 2nd ALL remission who presented to the same institution during the same time period but had no available transplant donor. The 15 BMT patients and 23 control patients had similar characteristics, with the exception that the BMT patients were significantly older at the time of ALL diagnosis (12.6 yr vs. 5.7 yr, P = 0.01). BMT patients had a significantly increased chance of remaining disease-free for 36 mo. from time on study (43% actuarial vs. 5%, P = 0.004) and a greater overall survival rate at 48 mo. (47% actuarial vs. 9, P = 0.27) than the conventionally treated patients. In all, 5 of the bone marrow transplant patients (33%) remain alive and free of disease 24-48+ mo. from transplantation. Several pre- and post-transplant characteristics were analyzed to determine predictive factors for a successful BMT outcome for patients with ALL in 2nd or subsequent remission. Significant risk factors for predicting leukemic relapse included initial white blood cell count (WBC) > 50,000/.mu.l at ALL diagnosis (100% relapse rate vs. 37% for patients with lower WBC, P = 0.001) and presence of any extramedullary disease pre-BMT (100% relapse rate vs. 37% for patient without extramedullary disease, P = 0.03). All 5 disease-free BMT survivors had initial WBC < 50,000/.mu.l and no evidence of extramedullary disease pretransplantation. Maintenance chemotherapy with 6-mercaptopurine (6MP) and methotrexate was given to 4 patients starting 100 day after bone marrow transplantation. Use of maintenance chemotherpy was associated with a significantly increased chance of remaining disease free (100% of patients surviving leukemia-free vs. 17% for patients not receiving maintenance chemotherapy, P = 0.02). Presence of graft-vs.-host disease (GVHD) did not influence leukemia-free survival. Intensive therapy followed by bone marrow transplantation apparently is the treatment of choice for patients with ALL in 2nd or subsequent remission who have a histocompatible sibling match. A controlled trial to evaluate the efficacy of maintenance chemotherapy post-BMT for ALL patients is warranted.