• Akio Shigematsu, Takeshi Kondo, Satoshi Yamamoto, Junichi Sugita, Masahiro Onozawa, Kaoru Kahata, Tomoyuki Endo, Soichi Shiratori, Shuichi Ota, Masato Obara, Kentaro Wakasa, Mutsumi Takahata, Yukari Takeda, Junji Tanaka, Satoshi Hashino, Mitsufumi Nishio, Takao Koike, Masahiro Asaka, and Masahiro Imamura.
• Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. shigemap@r9.dion.ne.jp
• Biol. Blood Marrow Transplant. 2008 May 1; 14 (5): 568-75.

AbstractWe retrospectively evaluated the outcomes of 37 adult patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT) conditioned with medium-dose VP-16 (VP, 30 mg/kg), cyclophosphamide (CY, 120 mg/kg), and fractionated total-body irradiation (TBI, 12 Gy) (medium-dose VP/CY/TBI). The median age of the patients was 26 years. Thirteen patients underwent transplantation from HLA-matched related donors (MRD), 18 patients underwent transplantation from HLA-matched unrelated donors (MUD), and 6 patients underwent transplantation from HLA-mismatched donors (MMD). Thirty-two patients received bone marrow and 4 patients received peripheral blood stem cells. Ten patients were Philadelphia chromosome-positive (Ph(+)) and 35 patients were in complete remission (CR) at transplantation. All of the patients achieved engraftment, and grade 3 organ toxicity before engraftment occurred in 27 patients. Grade II-III acute graft-versus-host disease (GVHD) and chronic GVHD (cGVHD) occurred in 15 and 18 patients, respectively. No patient developed grade IV acute GVHD (aGVHD) or died of GVHD. At median follow-up of 35.1 months, 32 patients were alive and all Ph(+) patients were alive. Three patients died of relapse and 2 died of transplant-related mortality (TRM). The actuarial 3-year overall survival (OS) rate, relapse rate, and TRM rate were 89.2%, 8.1%, and 5.4%, respectively. Non-CR at transplantation, MRD, and no aGVHD were significant adverse prognostic factors for survival. Medium-dose VP/CY/TBI for adult ALL patients was associated with lower relapse rate and no increase in toxicity, resulting in better survival.

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