Autologous stem cell transplant in ALL: who should we be transplanting in first remission?

Bone Marrow Transplantation
A R Mato, Selina M Luger

Abstract

Long-term disease-free survival (DFS) has been reported after autologous stem cell transplantation for acute lymphoblastic leukemia. Phase II studies have evaluated its role in first and subsequent complete remission (CR) with DFS rates of up to 50%. It has been under-utilized in 1st CR in part, due to a concern that patients who relapse after autologous stem cell transplantation (ASCT) have fewer options for salvage treatment of relapsed disease. Unfortunately, survival rates of <5% are reported in patients who relapse, regardless of initial therapy. Few prospective, randomized trials have analyzed large enough numbers of patients to allow us to determine the appropriate patient population for autologous transplantation. Although variability in the available studies makes it difficult to draw a definite conclusion, and many issues remain unresolved, available data suggests that there may be a group of patients for whom ASCT in first remission is a reasonable and perhaps superior treatment choice. Factors such as risk features at diagnosis, and minimal residual disease following induction therapy greatly affect outcome following ASCT. The available data as well as the questions that remain to be answered will be discussed and r...Continue Reading

References

Nov 1, 1993·Leukemia & Lymphoma·G Lambertenghi DeliliersE E Polli
Sep 20, 2002·Blood·Hervé DombretUNKNOWN Groupe d'Etude et de Traitement de la Leucémie Aiguë Lymphoblastique de l'Adulte (GET-LALA Group)
Apr 15, 2003·Leukemia & Lymphoma·Gerlinde EgererAnthony D Ho
Sep 9, 2004·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Xavier ThomasDenis Fiere
Apr 19, 2005·Bone Marrow Transplantation·H HallböökUNKNOWN Swedish Adult ALL Group
Nov 9, 2005·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Theresa HahnPhilip L McCarthy
Nov 22, 2005·Mayo Clinic Proceedings·Elias J JabbourHagop M Kantarjian

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Citations

Sep 25, 2008·Bone Marrow Transplantation·Ra Larson
Sep 22, 2006·Current Opinion in Oncology·Antonella VitaleRobin Foà
Jan 1, 2008·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Stella M DaviesFrederick R Appelbaum
Jan 25, 2017·Blood·David I Marks, Clare Rowntree

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