The role of maintenance chemotherapy after autotransplantation for acute lymphoblastic leukemia in first remission: Single-center experience of 100 patients

B. Sirohi, R. Powles, J. Treleaven, S. Kulkarni, R. Saso, M. Potter, M. Ethell, G. Morgan, S. Singhal, J. Mehta*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

A total of 100 adults with ALL in first CR received melphalan (110mg/ m2) with TBI followed by autologous marrow (n=35) or single-agent melphalan (200mg/m2) followed by autologous blood stem cells (n=65). After adequate hematologic recovery, maintenance chemotherapy with 6-mercaptopurine, methotrexate and vincristine-prednisone was administered for 2 years. Six patients, all TBI recipients (P=0.001), died of toxicity. In total 70 patients received 6-mercaptopurine, 53 received methotrexate and 40 received vincristine-prednisone. The cumulative incidence of relapse at 7 years was 45%. The 7-year probabilities of disease-free survival (DFS) and overall survival were 45 and 48%. Age 30 years, >4 weeks to attain remission, and karyotypes t(4;11) and t(9;22) were associated with adverse outcome. Patients with 0 (standard risk), 1 (intermediate risk), and 2-3 (high risk) adverse features had 7-year cumulative incidences of relapse of 19, 53 and 82% (P<0.0001), and 7-year DFS probabilities of 73, 36 and 7% (P<0.0001). The 7-year probabilities of DFS for patients receiving 0, 1, 2 and 3 maintenance chemotherapy agents were 15, 29, 58 and 61% (P<0.0001). Maintenance chemotherapy intensity was an independent determinant of outcome in Cox analysis. Maintenance chemotherapy after autotransplantation reduces relapse and improves outcome in adult patients with ALL.

Original languageEnglish (US)
Pages (from-to)105-112
Number of pages8
JournalBone Marrow Transplantation
Volume42
Issue number2
DOIs
StatePublished - Jul 2008

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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