Allogeneic transplantation for patients with advanced acute leukemia: a single center retrospective study of 92 patients

Allogeneic transplantation is a well recognized treatment strategy of leuke mia. However. its use in advanced leukemia patients is a subject of some de bate especially when donors are not HLA-identical siblings because of the t oxicity and cost of the procedure. We reviewed retrospectively the outcome of patients (pts) who received allogeneic transplantation For advanced acut e leukemia in our center between 09/86 and 11/97. Thirty-six pts (study gro up) who lacked a matched sibling donor received partially matched related d onor (n=14: PMRD group) or marched unrelated donor transplantation (n=22: M UD group). Fifteen pts had AML and 21 ALL. Seventeen pts (47%) were in CR > 1. 13 pts (36%) had refractory disease and six pts (17.7%) were in untreate d relapse. The outcome was compared to that of 56 patients (AML: 45.5 %. AL L: 55.5 %, CR >1: 49.9 %, refractory disease: 37.5 %, untreated relapse 19. 6 %) who received allogeneic transplantation from a matched sibling donor ( control group). Various conditioning regimens and GVHD prophylaxis were use d. The actuarial incidence of grade II to IV acute GVHD was significantly h igher in the study group (57%) than in the control group (34%) (p=0.047). T he actuarial risk of relapse at three years was 21% +/- 22% in the study gr oup versus 65% +/- 16%, in the control group (p=0.04). The actuarial probab ility of transplant-related mortality at 3 years is 64 +/- 16% for the stud y group and 25 +/- 11% for the control group (p=0.001). The leading cause o f death in the study group was infection (30%) followed by acute GVHD and r elapse. Relapse was the major cause of death in the control group (54%), fo llowed by infection, interstitial pneumonia. veno-occlusive disease and GVH D. The OS and probability of leukemia-free survival at 3 years were 28 % +/ - 15% (95% CI) and 27% +/- 15% (95% CI) in the study group. The overall sur vival and probability of LFS at 3 years were respectively 28 +/- 12% (95% C I) and 23 +/- 12% (95% Ci) in the control group (p = 0.08 and p=0.11 respec tively). In multivariate analysis, transplant-related mortality was higher in the study group (p=0.04) and lower if both donor and recipient were sero negative fur CMV (p=0.007). OS was significantly higher for seronegative co uples: (p=0.0001), and when CR was achieved before BMT (p=0.0022). These results suggest that all efforts in this field should be directed on lowering the transplant related mortality for non geno-identical transplant s and the relapse rate in gene-identical transplants.