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Allogeneic hemopoietic stem cell transplants for patients with relapsed acute leukemia: long-term outcome.

Bacigalupo A, Lamparelli T, Gualandi F, Occhini D, Bregante S, Raiola AM, Ibatici A, Grazia C, Dominietto A, Piaggio G, Podesta M, Bruno B, Lombardi A, Frassoni F, Viscoli C, Sacchi N, Lint MT

1Divisione di Ematologia 2, Ospedale San Martino, Genova, Italy.

We assessed the long-term outcome of patients with relapsed acute myeloid (n=86) or acute lymphoid leukemia (n=66), undergoing an allogeneic hemopoietic stem cell transplantation in our unit. The median blast count in the marrow was 30%. Conditioning regimen included total body irradiation (TBI) (10-12 Gy) in 115 patients. The donor was a matched donor (n=132) or a family mismatched donor (n=20). Twenty-two patients (15%) survive disease free, with a median follow-up of 14 years: 18 are off medications. The cumulative incidence of transplant related mortality is 40% and the cumulative incidence of relapse related death (RRD) is 45%. In multivariate analysis of survival, favorable predictors were chronic graft-versus-host disease (GvHD) (P=0.0003), donor other than family mismatched (P=0.02), donor age less than 34 years (P=0.02) and blast count less than 30% (P=0.07). Patients with all four favorable predictors had a 54% survival. In multivariate analysis of relapse, protective variables were the use of TBI (P=0.005) and cGvHD (P=0.01). This study confirms that a fraction of relapsed leukemias is cured with an allogeneic transplant: selection of patients with a blast count <30%, identification of young, human leukocyte antigen-matched donors and the use of total body radiation may significantly improve the outcome.Bone Marrow Transplantation (2007) 39, 341-346. doi:10.1038/sj.bmt.1705594; published online 5 February 2007.

Published 7 March 2007 in Bone Marrow Transplant, 39(6): 341-6.
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