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ctt-journal > Semenova et al. (Abstract)

Semenova et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract23

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Reduced intensity allogeneic transplantation in young patients with very high risk acute lymphoblastic leukemia (VHR ALL)

Elena V. Semenova, Natalia V. Stancheva, Alexander L. Alyanskiy, Elena V. Babenko, Olga A. Slesarchuk, Ludmila S. Zubarovskaya, Boris V. Afanasyev

R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia

Correspondence: Elena V. Semenova, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, L. Tolstoy str., Saint-Petersburg, 197022, Russia, E-mail: bmt-director@spam is badspmu.rssi.ru

Abstract

The aim: to analyze the efficacy of allo-HSCT with reduced intensity conditioning (RIC) in children and adolescents suffering from VHR ALL.

Patients and methods: Thirty-two ALL patients (pts) from 1 to 21 years old (median age 12 y) underwent allo-HSCT between 12/2002 and 12/2010. The indications for RIC allo-HSCT were poor performance status (Karnofsky (Lanskoy) index 80–50%), organ dysfunction due to previous therapy (co-morbidity), or infection complication at the moment of allo-HSCT. The disease status at the moment of alloHSCT was that 21 pts were in I or II complete remission (CR), and 11 pts were in resistant relapse. RIC consisted of Flu 150 mg/m2/d + Mel (140 mg/m2/d) ± ATG or Flu 150 mg/m2/d + Bu 8 mg/kg ± ATG.

Results (tables 1, 2): Median time to ANC engraftment (>=0.5x109/l) was 17.9 days (range 13–31) in 28 pts. Graft failure occurred in 4 pts. OS and DFS were 46% and 32% respectively. Five pts died within 100 days due to infection (n=1) or aGVHD (n=4). Relapse occurred in 6 pts (28%) (median time 5 months after alloHSCT; range 1–13 months). Three relapsed pts achieved CR after chemotherapy+DLI and 2 pts after immunosuppression withdrawal, and only one pt died due to relapse in 5 months despite a second allo-HSCT. CR was achieved in 5 of 11 pts after alloHSCT at resistant relapse, but all of these patients died due to infection (n=3), aGVHD (n=1), and disease progression (n=7).

Conclusion: These results make new approaches for pts with VHR ALL, indicate sensitivity to immunoadoptive therapy and produce the base for clinical trials.

Table 1. Outcomes after allo-HSCT

Status at the moment of allo-HSCT

Relapse
n (%)

100d TRM
n (%)

OS

EFS

CR I or II, n=21

6 (28)

7 (23)

45%

32%

Relapse, n=11

7 (63)

4 (36)

0

0

Cell Ther Transplant. Vol. 3, No. 12. doi:10.3205/ctt-2011-No12-abstract23-table1

 
Table 2. Complications after allo-HSCT

Complications

%

Acute GVHD grade 1–4

55

Chronic GVHD

61

Fungal infections

16

Bacterial infections

16

Viral infections  (CMV)

55

Non-hematological toxicity

25

Hemorrhagic

11

Cell Ther Transplant. Vol. 3, No. 12. doi:10.3205/ctt-2011-No12-abstract23-table2


Keywords:
reduced intensity conditioning, acute lymphoblastic leukemia