For adults with high-risk or recurrent ALL who lack a suitable sibling donor, the decision between autologous (Auto) and unrelated donor (URD) hematopoietic stem cell transplantation (HSCT) is difficult due to variable risks of relapse and treatment-related mortality (TRM). We analysed data from two transplant registries to determine outcomes between Auto and URD HSCT for 260 adult ALL patients in first (CR1) or second (CR2) CR. All patients received a myeloablative conditioning regimen. The median follow-up was 77 (range 12-170) months. TRM at 1 year post transplant was significantly higher with URD HSCT; however, there were minimal differences in TRM according to disease status. Relapse was higher with Auto HSCT and was increased in patients transplanted in CR2. Five-year leukemia-free (37 vs 39%) and overall survival (OS) rates (38 vs 39%) were similar for Auto HSCT vs URD HSCT in CR1. There were trends favoring URD HSCT in CR2. The long-term follow-up in this analysis demonstrated that either Auto or URD HSCT could result in long-term leukaemia-free survival and OS for adult ALL patients. The optimal time (CR1 vs CR2) and technique to perform HSCT remains an important clinical question for adult ALL patients.
Bibliographical noteFunding Information:
The CIBMTR is supported by Public Health Service Grant U24-CA76518 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute; Office of Naval Research; Health Services Research Administration (DHHS); and grants from AABB; Abbott Laboratories; Aetna; AIG Medical Excess; American Red Cross; Amgen Inc.; Anonymous donation to the Medical College of Wisconsin; AnorMED Inc.; Astellas Pharma US Inc.; Berlex Laboratories Inc.; Biogen IDEC Inc.; Blue Cross and Blue Shield Association; BRT Laboratories Inc.; Celgene Corp.; Cell Therapeutics Inc.; CelMed Biosciences; Cubist Pharmaceuticals; Dynal Biotech, LLC; Edwards Lifesciences RMI; Endo Pharmaceuticals Inc.; Enzon Pharmaceuticals Inc.; ESP Pharma; Gambro BCT Inc.; Genzyme Corporation; GlaxoSmithKline Inc.; Histogenetics Inc.; Human Genome Sciences; International Waldenstrom Macroglobulinemia Foundation; Kirin Brewery Company; Ligand Pharmaceuticals Inc.; Merck & Company; Millennium Pharmaceuticals; Miller Pharmacal Group; Milliman USA Inc.; Miltenyi Biotec; National Center for Biotechnology Inform ation; National Leukemia Research Association; National Marrow Donor Program; Nektar Therapeutics; NeoRx Corporation; Novartis Pharmaceuticals Inc.; Novo Nordisk Pharmaceuticals; Ortho Biotech Inc.; Osiris Therapeutics Inc.; Pall Medical; Pfizer Inc.; Pharmion Corp.; Protein Design Labs Inc.; QOL Medical; Roche Laboratories; StemCyte Inc.; Stemco Biomedical; StemSoft Software Inc.; SuperGen Inc.; Sysmex; The Marrow Foundation; THERAKOS, a Johnson & Johnson Co.; University of Colorado Cord Blood Bank; Valeant Pharmaceuticals; ViaCell Inc.; ViraCor Laboratories; WB Saunders Mosby Churchill; Wellpoint Inc.; and Zelos Therapeutics Inc. The views expressed in this article do not reflect the official policy or position of the National Cancer Institute, the Depart ment of the Navy, the Department of Defense, or the Government of the United States.
This research has been supported by funding from the National Marrow Donor Program, the Health Resources and Services administration No. 240-97-0036 and the Office of Naval Research N00014-96-2-0016 and N00014-99-2-0006 to the National Marrow Donor Program.