MIAMI BEACHLong-term follow-up of 23 patients with
Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia
(ALL) in first complete remission showed a relatively low relapse
rate at 3 years when treated with allogeneic bone marrow transplant
from HLA-matched siblings, D.S. Snyder, MD, reported at the American
Society of Hematology (ASH) annual meeting.
Being positive for the Philadelphia chromosome is an extremely
poor-risk factor for pediatric and adult ALL patients, said Dr.
Snyder, of the City of Hope National Medical Center, Duarte,
In this study, from City of Hope and Stanford University, patients
were treated between 1984 and 1997. All patients but one were
conditioned with fractionated total body irradiation (TBI) (1,320
cGy) and high-dose etoposide (60 mg/kg). One patient received
high-dose cyclophosphamide instead of etoposide, and another patient
received both drugs.
Nine patients died following transplanttwo from relapsed
leukemia and seven from transplant-related causes. The 3-year
probabilities of disease-free survival and relapse were 65% and 12%,
respectively. The 3-year probabilities for patients who were
transplanted after 1992 were 81% and 11%, respectively.
The study did not show any differ-ences in risks of relapse or
disease-free survival based on the expression of p190 vs p210 bcr-abl
oncogene, Dr. Snyder said, and the relatively low relapse rate may
reflect enhanced antileukemic activity of etoposide/TBI, compared to
He noted that the favorable disease-free survival for patients
transplanted after 1992 may be explained by improvements in
supportive care, specifically the prevention and treatment of fungal
and cytomegalovirus (CMV) infections.