Open AccessNon-myeloablative stem cell transplantation in patients with relapsed acute lymphoblastic leukemia: results of a multicenter study
Author(s) -
César Homero Gutiérrez-Aguirre,
David GómezAlmaguer,
Olga Graciela Cantú-Rodrı́guez,
Óscar González-Llano,
José Carlos JaimePérez,
S Herena-Perez,
Carlos Manzano,
Roberto Estrada-Gómez,
Martha L. González-Carrillo,
Guillermo J. RuízArgüelles
Publication year - 2007
Publication title -
bone marrow transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 127
eISSN - 1476-5365
pISSN - 0268-3369
DOI - 10.1038/sj.bmt.1705769
Subject(s) - medicine , busulfan , fludarabine , cyclophosphamide , transplantation , hematopoietic stem cell transplantation , methotrexate , surgery , gastroenterology , chemotherapy , leukemia
Using non-myeloablative conditioning, allogeneic hematopoietic stem cell transplantation (HSCT) was conducted in 43 ALL patients in a CR2. The median age of the patients was 19 years. Patients received oral busulfan 4 mg/kg/day for 2 days; i.v. cyclophosphamide 350 mg/m(2)/day for 3 days; and i.v. fludarabine 30 mg/m(2)/day for 3 days. Oral cyclosporin A 4 mg/kg was started and methotrexate 5 mg/m(2) was delivered on days 1, 3, 5 and 11. The median CD34+ cell dose received was 5.0 x 10(6)/kg. The medium time to achieve a granulocyte count above 0.5 x 10(9)/l was 14 days. Thirteen patients were alive 30-1050 days after the HSCT. The 3-year overall survival rate was 30%. Ten patients (23%) developed acute GVHD, whereas eight patients (18.6%) developed chronic GVHD. Thirty patients died between days 47 and 1050 after the HSCT, most of them (70%) because of an ALL relapse. One hundred-day mortality was 15%, whereas transplant-related mortality was 21%. These results are inferior to those obtained using the same allografting method in other leukemias, probably as a consequence of poor susceptibility to the graft-versus-leukemia effect of the ALL cells beyond first remission as compared with other hematological malignancies.