Proceedings of the 2nd Meeting of the Asian Cellular Therapy Organization
نویسندگان
چکیده
Proceedings of the 2nd Meeting of the Asian Cellular Therapy Organization; Published online 30 Nov 2011 Adult acute lymphoblastic leukemia (ALL) is one of the intractable diseases in hematological malignancies, showing about 30% long-term survival by intensive chemotherapies with high incidence of relapse. Allogeneic hematopoietic stem cell transplantation (allogeneic HSCT) has been therefore applied to many such patients, showing better responses than chemotherapy and autologous HSCT, although there were some controversial results regarding a timing of allogeneic HSCT, especially in standard-risk ALL patients. In general, a better outcome (about 40% to 60% long-term survival) is obtained when adult high-risk patients in first complete remission (CR1) or second complete remission (CR2) received allogeneic HSCT using conventional myeloablative conditioning (MAC) regimens.Long-termsurvival decreased depending on the remission status; namely, about 20-40% in CR2, 10-20% in ≧CR3, and about 10%in non-CR. The most common MAC regimens for allogeneic HSCT in ALL patients are 120 mg/kg cyclophosphamide (CY) plus 12 to 13.2 gray (Gy) fractionated total body irradiation (TBI). By these conditioning regimens, the 3-year overall survival (OS) rate of about 50% was obtained when it was performed in CR1.In fact, when we analyzedthedata for 515 patients aged 15 to 59 years who received allogeneic HSCT in CR1 or CR2 with CY/TBI regimen between 1993 and 2007 from the Japan Society for Hematopoietic Cell Transplantation data base and the Japan Marrow Donor Program data base, the 5-year OS rate was 55.2%. In contrast, we have used medium-dose VP-16 in addition to conventional CY/TBI regimen to eradicate minimal residual disease. This regimen showed an excellent outcome in adult ALL patients transplanted in CR1, resulting in the 3-year OS rate of 89.2% without increasing the 3-year relapse rate (8.1%) and transplant-related mortality (TRM) rate (5.4%). Reduced-intensity conditioning (RIC) regimens are also applied for adult ALL patients with favorable outcomes (the 2to 3year OS rate: 30% to 60%); however, the 2to 3year relapse rate (20% to 40%) and TRM rate (20% to 30%) are still high. Therefore, a suitable conditioning regimen in allogeneic HSCT for adult ALL patients aged younger 50 years old in CR1 appears to be medium-dose VP/CY/TBI, while RIC regimens are preferable for patients aged over 50 years old or younger patients with some complications. Proceedings of the 2nd Meeting of the Asian Cellular Therapy Organization
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عنوان ژورنال:
دوره 7 شماره
صفحات -
تاریخ انتشار 2011