Marrow transplantation for patients with acute lymphoblastic leukemia in remission

Abstract Twenty-two patients with acute lymphoblastic leukemia (ALL) in second or subsequent remission and 26 with ALL in relapse were given cyclophosphamide (60 mg/kg on each of 2 days), total-body irradiation (920 rad). and a marrow transplant from an HLA-identical sibling. With a minimum follow-up of more than 1 yr, an actuarial analysis shows a decrease in death from nonleukemic causes (p = 0.07) and a decrease in recurrence of leukemia (p = 0.05), resulting in a significant improvement in survival (p = 0.002) for those patients transplanted in remission. A proportional hazards regression analysis was used to evaluate various parameters known to be of prognostic importance in the chemotherapy of ALL. These parameters did not account for the observed difference in relapse rates between the patients transplanted in remission and those transplanted in relapse, and only the presence of or a history of central nervous system involvement contributed significant additional prognostic information. Supportive care requirements and time in the hospital for the patients transplanted in remission were less than for patients transplanted in relapse. Eleven of the 22 transplanted in remission and 4 of the 26 transplanted in relapse are alive 15-35 mo after transplantation. The improved survival of the patients transplanted in remission indicates that the risks and complications of marrow grafting are offset by the probability of a long-term remission. For the patient with an HLA-identical sibling, marrow transplantation should be undertaken before the stage of terminal relapse is reached.