Bone marrow transplantation (BMT) for acute lymphoblastic leukemia (ALL) in remission

Thirty-two patients with acute lymphoblastic leukemia (ALL) were given cyclophosphamide, 120 mg/kg, and total body irradiation (TBI), 10-12 Gy, followed by an allergic bone marrow transplant (BMT). Seven patients were in their first remission: 4 survived 8-24 months post-BMT and 3 died of BMT-related complications. Twenty-five patients were in their second remission: 12 survived, 7-50 months post-BMT. The actuarial survival for patients in 1st and 2nd CR is 57% and 40 %, respectively (p = 0.1). The overall survival for patients less than or older than 15 years of age is 73% and 50%, respectively (p = 0.2). The actuarial risk of relapse is currently 0% and 50% for 1st and 2nd CR patients (p = 0.06). Factors influencing relapse in 2nd CR patients are the length of first remission (p = 0.01), the severity of acute GvHD (p = 0.02), and the severity of chronic GvHD (p = 0.03). This study points out an age-dependent tolerance of transplant procedures in ALL, and a high relapse rate in 2nd remission patients, possibly influenced by the duration of first remission and the severity of GvHD.