Allogeneic bone marrow transplantation for acute lymphoblastic leukaemia: risk factors and clinical outcome


Dr Daniel J. Weisdorf, Division of Hematology, University of Minnesota, Box 480 UMHC, Harvard Street at East River Road, Minneapolis, MN 55455, U.S.A.


We report 12 years’experience with histocompatible, related donor marrow transplantation for 123 patients with acute lymphoblastic leukaemia; 104 geqslant R: gt-or-equal, slantedsecond remission. Four regimens were studied: cyclophosphamide (Cy)+total body irradiation (TBI) (n= 35); Cy + fractionated TBI (n= 45); TBI + high-dose cytarabine (n= 15); and hyperfractionated TBI + Cy (n= 28). 45 patients survive (34 ± 9%: 95% confidence interval) between 1 and 12·7 years (median 7·8 years) following BMT and 29 ± 8% survive leukaemia-free. Significantly improved disease-free survival was observed in patients with an initial WBC < 50 x 109/l (P= 0·02). Conditioning regimens tested yielded similar outcomes, though TBI/cytarabine led to greater treatment associated mortality. Leukaemia relapse was the most frequent cause of failure in 56 ± 11%; median time of relapse 8 months following BMT, none beyond 2·2 years. Relapse was more frequent with higher WBC, shorter initial remission and previous CNS leukaemia. Acute and/or chronic GVHD was associated with a strong trend (P= 0·06) towards less relapse. Allogeneic BMT may be curative for a substantial fraction of patients with ALL, but additional anti-leukaemic measures beyond these conditioning modifications tested will be required to prevent post-transplant leukaemia recurrence.