Role of hemopoietic stem cell transplantation in therapy of adult patients with acute leukemias

Abstract

In 1990 to 2005, a total of 138 hematopietic stem cell transplantations (HSCT) were made in patients with high risk group of acute myeloblastic leukemia (AML) (auto-HSCT in 20 patients, related allo-HSCT in 18, unrelated allo-HSCT in 20) and acute lymphoblastic leukemia (ALL) (auto-HSCT in 13 patients, related allo-HSCT in 24, unrelated allo-HSCT in 43). The patients' age was 2 to 55 years. Five-year relapse-free survival after auto-HSCT in the 1st-2nd remissions in AML was 40%; 8-year one was 30% in patients with ALL (including 3 patients with Ph+). In patients aged less than 21 years with acute leukemias, 5-year overall survival after related and unrelated donor allo-HSCT was 38 and 44%, respectively. Both allo-HSCT modes had the similar spectrum of complications in the early period (as long as 100 days). In patients with AML and ALL, 5-year overall survival depended on the stage of disease at the moment of allo-HSCT performance (52 and 5.9% in ALL and 62.5 and 27.3% in AML, remission and relapse, respectively). Auto- HSCT in ALL and AML is an effective method for remission consolidation and may be regarded as an alternative if the patient has no related or unrelated donor. The efficacy of allo-HSCT from a related or unrelated donor in acute leukemia depends on the stage of disease at the moment of its per- formance, which determines the likelihood of development of a relapse and different complications (toxic, infectious, graft rejection, etc).

Keywords

• acute leukemias
• transplantation
• related and unrelated donors