Case Report

International Journal of Hematology

, 94:291

First online:

Sequential chemotherapy and myeloablative allogeneic hematopoietic stem cell transplantation for refractory acute lymphoblastic leukemia

  • Kotaro AritaAffiliated withStem Cell Transplantation Center, Hokkaido University HospitalThird Department of Internal Medicine, Graduate School of Medicine, University of Toyama Email author 
  • , Takeshi KondoAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Junichi SugitaAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Akio ShigematsuAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Souichi ShiratoriAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Kentaro WakasaAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Atsushi YasumotoAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Makoto IbataAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
  • , Yusuke ShonoAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Misato KikuchiAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Hideki GotoAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Yukari TakedaAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Mutsumi TakahataAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Naoko KatoAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Mitsufumi NishioAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Shuichi OtaAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Junji TanakaAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital
    • , Masahiro ImamuraAffiliated withStem Cell Transplantation Center, Hokkaido University Hospital

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Abstract

The prognosis of patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) for refractory acute lymphoblastic leukemia (ALL) is very poor. To improve survival rates, we attempted to intensify the conditioning regimen with daunorubicin, vincristine, prednisolone, medium-dose etoposide, cyclophosphamide, and total body irradiation (DNR/VCR/PSL plus medium-dose VP/CY/TBI). Four patients in relapse or induction failure of B-precursor ALL without other complications underwent allogeneic HSCT. Initially, chemotherapy comprising DNR 60 mg/m2 for 3 days, VCR 1.4 mg/m2 for 1 day, and PSL 60 mg/m2 for 3 days was administered, which was followed by medium-dose VP/CY/TBI; some modifications were made for individual patients. All patients achieved engraftment and complete remission after HSCT. Regimen-related toxicities were tolerable and no patient died within 100 days. Two patients were alive without disease on days 563 and 1,055. The third patient relapsed on day 951, while the fourth died on day 179 without disease. Our results indicate that intensified myeloablative HSCT should be considered for patients with refractory ALL.

Keywords

Acute lymphoblastic leukemia Allogeneic hematopoietic stem cell transplantation Non-CR Refractory leukemia Induction failure