Acute Lymphoblastic Leukemia (ALL) Outcomes
The survival graphs below illustrate outcomes of unrelated donor hematopoietic cell transplants (bone marrow, PBSC, or cord blood transplants — BMT) facilitated by the National Marrow Donor Program (NMDP) for both adult and pediatric patients.
NMDP outcomes for adult ALL patientsFive-year survival for adult patients (> 18 years of age) transplanted for acute lymphoblastic leukemia (ALL) using marrow (Figure 1) or peripheral blood stem cells (PBSC) (Figure 2) is significantly increased in patients transplanted in first complete remission compared to those patients transplanted in second complete remission or those with advanced disease (log-rank p-value < 0.0001).
Since only a small percentage of adult ALL patients achieve complete remission after relapse, it is important to identify those patients with poor-risk cytogenetics at diagnosis. These patients should be referred for transplant at time of first complete remission so that an unrelated donor or cord blood unit can be identified early.
A large-scale, multi-center phase III clinical trial is underway to determine if graft source (PBSC or marrow) affects transplant outcomes in unrelated donor transplantation for ALL and other hematologic malignancies. The trial is being conducted through the Blood and Marrow Transplant Clinical Trials Network (BMT CTN Study 0201). [1]
Figure 1.
Acute lymphoblastic leukemia: Survival of adult marrow myeloablative transplant patients by disease stage 1998-2006.(NMDP data)
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Adult marrow transplants facilitated by the NMDP,
1998-2006 |
| Disease Stage |
# of Transplants |
Kaplan-Meier 5-Year Survival* |
| 1st complete remission |
195 |
45% ± 8% |
| 2nd complete remission |
179 |
21% ± 7% |
| Advanced disease |
218 |
7% ± 4% | * 95% confidence interval
Figure 2.
Acute lymphoblastic leukemia: Survival of adult PBSC myeloablative transplant patients by disease stage 1998-2006.(NMDP data)
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Adult PBSC transplants facilitated by the NMDP,
1998-2006 |
| Disease Stage |
# of Transplants |
Kaplan-Meier 5-Year Survival* |
| 1st complete remission |
193 |
35% ± 9% |
| 2nd complete remission |
152 |
21% ± 9% |
| Advanced disease |
157 |
15% ± 7% | * 95% confidence interval
NMDP outcomes for pediatric ALL patientsFive-year survival for pediatric patients (<18 years of age) transplanted for ALL is significantly increased for patients in first complete remission and second complete remission compared to patients with advanced disease at the time of transplant (log-rank p-value < 0.0001).
Figure 3.
Acute lymphoblastic leukemia: Survival of pediatric myeloablative marrow transplant patients by disease stage 1998-2006. (NMDP data)
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| ALL pediatric myeloablative marrow transplants facilitated by the NMDP, 1998-2006 |
| Disease Stage |
# of Transplants |
Kaplan-Meier 5-Year Survival* |
| 1st complete remission |
138 |
54% ± 10% |
| 2nd complete remission |
280 |
49% ± 7% |
| Advanced disease |
146 |
26% ± 8% | * 95% confidence interval
References
- BMT CTN Protocol 0201 - A Phase III randomized multicenter trial comparing G-CSF mobilized peripheral blood stem cell with marrow transplantation from HLA compatible unrelated donors.
https://web.emmes.com/study/bmt/protocol/0201__protocol/0201__protocol.html
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