Allogeneic Stem Cell Transplantation for Acute Lymphoblastic Leukaemia in Adults

  • David I. Marks
Chapter
First Online:
Part of the Contemporary Hematology book series (CH)

Abstract

The results of all therapies for adults with acute lymphoblastic leukaemia remain disappointing. Five year survival of the 1929 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 feeling that chemotherapy cannot be pushed much further. Younger (<25-30 years) patients are being treated on more intensive “pediatric” protocols with more asparaginase but there are no mature multicenter data available to evaluate the efficacy of this approach. B cell antibodies are being pursued by a number of groups, nelarabine is being trialled 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 a better definition of adverse risk factors [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 MRD at 9 time points in the first year of acute lymphoblastic leukaemia (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 (Table 13-1).

Keywords

Acute Lymphoblastic Leukaemia Acute GVHD Chronic GVHD Unrelated Donor Sibling Donor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • David I. Marks
    • 1
  1. 1.University Hospitals of Bristol, Oncology Day Beds, Bristol Children’s HospitalBristolUK

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