Hematopoietic stem-cell transplantation for acute leukemia in relapse or primary induction failure.


Journal Article

PURPOSE: Patients with acute leukemia refractory to induction or reinduction chemotherapy have poor prognoses if they do not undergo hematopoietic stem-cell transplantation (HSCT). However, HSCT when a patient is not in complete remission (CR) is of uncertain benefit. We hypothesized that pretransplantation variables may define subgroups that have a better prognosis. PATIENTS AND METHODS: Overall, 2,255 patients who underwent transplantation for acute leukemia in relapse or with primary induction failure after myeloablative conditioning regimen between 1995 and 2004 were reported to the Center for International Blood and Marrow Transplant Research. The median follow-up of survivors was 61 months. We performed multivariate analysis of pretransplantation variables and developed a predictive scoring system for survival. RESULTS: The 3-year overall survival (OS) rates were 19% for acute myeloid leukemia (AML) and 16% for acute lymphoblastic leukemia (ALL). For AML, five adverse pretransplantation variables significantly influenced survival: first CR duration less than 6 months, circulating blasts, donor other than HLA-identical sibling, Karnofsky or Lansky score less than 90, and poor-risk cytogenetics. For ALL, survival was worse with the following: first refractory or second or greater relapse, > or = 25% marrow blasts, cytomegalovirus-seropositive donor, and age of 10 years or older. Patients with AML who had a predictive score of 0 had 42% OS at 3 years, whereas OS was 6% for a score > or = 3. Patients with ALL who had a score of 0 or 1 had 46% 3-year OS but only 10% OS rate for a score > or = 3. CONCLUSION: Pretransplantation variables delineate subgroups with different outcomes. HSCT during relapse can achieve long-term survival in selected patients with acute leukemia.

Full Text

Duke Authors

Cited Authors

  • Duval, M; Klein, JP; He, W; Cahn, J-Y; Cairo, M; Camitta, BM; Kamble, R; Copelan, E; de Lima, M; Gupta, V; Keating, A; Lazarus, HM; Litzow, MR; Marks, DI; Maziarz, RT; Rizzieri, DA; Schiller, G; Schultz, KR; Tallman, MS; Weisdorf, D

Published Date

  • August 10, 2010

Published In

Volume / Issue

  • 28 / 23

Start / End Page

  • 3730 - 3738

PubMed ID

  • 20625136

Pubmed Central ID

  • 20625136

Electronic International Standard Serial Number (EISSN)

  • 1527-7755

Digital Object Identifier (DOI)

  • 10.1200/JCO.2010.28.8852


  • eng

Conference Location

  • United States