ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR ACUTE LYMPHOBLASTIC-LEUKEMIA - RISK-FACTORS AND CLINICAL OUTCOME

We report 12 years' experience with histocompatible, related donor mar row transplantation for 123 patients with acute lymphoblastic leukaemi a; 104 greater than or equal to second remission. Four regimens were s tudied: cyclophosphamide (Cy)+total body irradiation (TBI) (n=35); Cyfractionated TBI (n=45); TBI+high-dose cytarabine (n=15); and hyperfra ctionated TBI+CY (n=28). 45 patients survive (34+/-9%; 95% confidence interval) between 1 and 12.7 years (median 7.8 years) following BMT an d 29+/-8% survive leukaemia-free. Significantly improved disease-free survival was observed in patients with an initial WBC <50x10(9)/l (P=0 02). Conditioning regimens tested yielded similar outcomes, though TBI /cytarabine led to greater treatment-associated mortality. Leukaemia r elapse was the most fre quent cause of failure in 56+/-11%; median tim e of relapse 8 months following BMT, none beyond 2.2 years. Relapse wa s more frequent with higher WBC, shorter initial remission and previou s CNS leukaemia. Acute and/or chronic GVHD was associated with a stron g trend (P=006) towards less relapse. Allogeneic BMT may be curative f or a substantial fraction of patients with ALL, but additional anti-le ukaemic measures beyond these conditioning modifications tested will b e required to prevent post-transplant leukaemia recurrence.