Sequential chemotherapy and myeloablative allogeneic hematopoietic stem cell transplantation for refractory acute lymphoblastic leukemia
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.
KeywordsAcute lymphoblastic leukemia Allogeneic hematopoietic stem cell transplantation Non-CR Refractory leukemia Induction failure
The authors sincerely thank all the involved clinical staff.
Conflict of interest
None of the authors has a conflict of interest.
- 1.Shigematsu A, Kondo T, Yamamoto S, Sugita J, Onozawa M, Kahata K, et al. Excellent outcome of allogeneic hematopoietic stem cell transplantation using a conditioning regimen with medium-dose VP-16, cyclophosphamide and total-body irradiation for adult patients with acute lymphoblastic leukemia. Biol Blood Marrow Transplant. 2008;14:568–75.CrossRefPubMedGoogle Scholar
- 8.Schmid C, Schleuning M, Schwerdtfeger R, Hertenstein B, Mischak-Weissinger E, Bunjes D, et al. Long-term survival in refractory acute myeloid leukemia after sequential treatment with chemotherapy and reduced-intensity conditioning for allogeneic stem cell transplantation. Blood. 2006;108:1092–9.CrossRefPubMedGoogle Scholar
- 10.Liu QF, Fan ZP, Zhang Y, Jiang ZJ, Wang CY, Xu D, et al. Sequential intensified conditioning and tapering of prophylactic immunosuppressants for graft-versus-host disease in allogeneic hematopoietic stem cell transplantation for refractory leukemia. Biol Blood Marrow Transplant. 2009;15:1376–85.CrossRefPubMedGoogle Scholar
- 13.Durrant IJ, Prentice HG, Richards SM. Intensification of treatment for adults with acute lymphoblastic leukemia: results of U.K. Medical Research Council randomized trial UKALL XA. Medical Research Council Working Party on Leukaemia in Adults. Br J Haematol. 1997;99:84–92.CrossRefPubMedGoogle Scholar
- 15.Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, et al. Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Support Care Cancer. doi: 10.1007/s00520-011-1116-x (published online February 15, 2011).
- 20.Schindler J, Gajavelli S, Ravandi F, Shen Y, Parekh S, Braunchweig I, et al. A phase I study of a combination of anti-CD19 and anti-CD22 immunotoxins (Combotox) in adult patients with refractory B-lineage acute lymphoblastic leukaemia. Br J Haematol. doi: 10.1111/j.1365-2141.2011.08762.x (published online July 7, 2011).