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Allogeneic bone marrow transplantation for patients with high-risk acute lymphoblastic leukemia.
Wingard, J R; Piantadosi, S; Santos, G W; Saral, R; Vriesendorp, H M; Yeager, A M; Burns, W H; Ambinder, R F; Braine, H G; Elfenbein, G.
Afiliación
  • Wingard JR; Bone Marrow Transplantation Program, Johns Hopkins Oncology Center, Baltimore, MD 21205.
J Clin Oncol ; 8(5): 820-30, 1990 May.
Article en En | MEDLINE | ID: mdl-2332770
Seventy-four consecutive patients with high-risk acute lymphoblastic leukemia (ALL) were given cyclophosphamide (CY; 50 mg/kg on each of 4 days) plus total body irradiation (TBI; 300 rad on each of 4 days) followed by a human leukocyte antigen (HLA)-identical allogeneic bone marrow transplant (BMT). Eighteen patients in first complete remission (CR1), 36 in CR2, 16 in CR3, and four in CR4 were transplanted. Patients in CR1 were transplanted 1 to 8 months (median, 3 months) after attaining CR. All 18 patients in CR1 had one or more poor risk factors: age more than 18 (N = 17), initial leukocyte count greater than or equal to 20,000 (N = 11), Ph 1 chromosome (N = 2), delay in attaining CR more than 6 weeks (N = 8), or extramedullary disease (N = 1). Of those transplanted in CR2, 72% had relapsed on therapy. The 5-year event-free survival (EFS) rates for patients transplanted in CR1, CR2, and CR3 are 42%, 43%, and 25%, respectively, at median follow-up times of 57, 54, and 72 months, respectively. Children aged less than 18 years transplanted in CR2 have a 5-year EFS rate of 54%. All CR4 patients died early after transplant. The actuarial probability of relapse is 20%, 26%, and 48% for those transplanted in CR1, CR2, and CR3, respectively. Although there was substantial transplant-associated mortality, it decreased over the decade of the study (P = .01). This study indicates that BMT offers an attractive alternative to postremission chemotherapy in patients in CR1 with poor prognostic factors and in patients in second remission.
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Trasplante de Médula Ósea / Leucemia-Linfoma Linfoblástico de Células Precursoras Tipo de estudio: Etiology_studies / Prognostic_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: J Clin Oncol Año: 1990 Tipo del documento: Article
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Trasplante de Médula Ósea / Leucemia-Linfoma Linfoblástico de Células Precursoras Tipo de estudio: Etiology_studies / Prognostic_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: J Clin Oncol Año: 1990 Tipo del documento: Article