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Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukaemia in Adults

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Adult Acute Lymphocytic Leukemia

Part of the book series: Contemporary Hematology ((CH))

Abstract

The results of all therapies for adults with acute lymphoblastic leukaemia remain disappointing. Five-year survival of the 1,929 intensively treated patients in the UKALL XII/ECOG 2993 study was 39% [1]. Chemotherapy is toxic and prolonged; this study reported a 12% 2-year non-relapse mortality in patients without donors. There is a belief that chemotherapy cannot be pushed much further. Younger (<25–30 years) patients are being treated on more intensive “paediatric” protocols with more asparaginase but there are no mature multicentre data available to evaluate the efficacy of this approach. B cell antibodies are being pursued by a number of groups, nelarabine is being evaluated upfront for T cell disease and the early experience with forodesine looks promising but increasing the doses or intensity of the standard drugs seems unlikely to produce significant survival benefits. There has been better definition of adverse risk factors using cytogenetics [2] in recent times, enabling us to target patients likely to fail chemotherapy with our most aggressive therapies. The 5-year overall survival of patients with t(4;11), low hypodiploidy/near triploidy or >5 abnormalities were 24%, 22%, and 28%, respectively, making these patients valid targets for more aggressive approaches. In addition, a major German study of minimal residual disease (MRD) at nine timepoints in the first year of ALL therapy has found that patients with molecular MRD detectable at week 16 have a very poor outcome (12% vs 66%) [3] making these patients logical candidates for trials of different approaches including upfront allografting.

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Authors and Affiliations

  1. Oncology Day Beds Bristol Children’s Hospital, University Hospitals of Bristol, Upper Maudlin Street, Bristol, UK, BS2 8BJ

    David I. Marks

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  1. David I. Marks
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Correspondence to David I. Marks .

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  1. Cleveland Clinic Foundation, Euclid Ave. 9500, Cleveland, 44195, Ohio, USA

    Anjali S. Advani

  2. School of Medicine, University Hospitals of Cleveland, Euclid Avenue 11100, Cleveland, 44106, Ohio, USA

    Hillard M. Lazarus

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Marks, D.I. (2011). Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukaemia in Adults. In: Advani, A., Lazarus, H. (eds) Adult Acute Lymphocytic Leukemia. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-60761-707-5_18

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  • DOI: https://doi.org/10.1007/978-1-60761-707-5_18

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  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-706-8

  • Online ISBN: 978-1-60761-707-5

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