uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Autologous and allogeneic stem cell transplantation in adult ALL: The Swedish Adult ALL Group experience
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
Show others and affiliations
2005 (English)In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 35, no 12, 1141-1148 p.Article in journal (Refereed) Published
Abstract [en]

Adult patients with acute lymphoblastic leukaemia (ALL) have been treated according to national protocols in Sweden since 1986. Stem cell transplantation (SCT) has been recommended in first remission for patients with risk factors for relapse, and for standard risk patients only after relapse. In this retrospective study, the results of autologous and allogeneic SCT in these populations were evaluated. In total, 187 patients with a median age of 34 years (17-66 years) underwent SCT. The 5-year disease-free survival (DFS), for all patients, was 26% (Confidence intervals (CI) 20-32%). The 5-year DFS was higher for patients transplanted in first remission 32% (CI 24-40%) compared to 14% (CI 5-23%; P<0.0001) in patients transplanted beyond first remission. No significant differences in DFS (P=0.06) were determined between autologous, related donor and unrelated donor SCT in the whole cohort. A lower relapse rate was counterbalanced by higher treatment-related mortality in patients undergoing allogeneic SCT. In Philadelphia-positive ALL, allogeneic SCT was superior to autologous SCT, with a 5-year DFS of 30% (CI 12-47%) vs 0% (P=0.04). Limited chronic graft-versus-host-disease (GVHD) was associated with an improved DFS of 53% (CI 38-69%) compared to no chronic GVHD of 22% (CI 10-36%; P=0.0008), indicating a clinically important graft-versus-leukaemia effect.

Place, publisher, year, edition, pages
2005. Vol. 35, no 12, 1141-1148 p.
Keyword [en]
Adolescent, Adult, Aged, Comparative Study, Disease-Free Survival, Female, Graft vs Host Disease, Graft vs Leukemia Effect, Hematopoietic Stem Cell Transplantation/*methods, Humans, Leukemia; Lymphocytic; Acute; L2/*therapy, Male, Middle Aged, Philadelphia Chromosome, Probability, Recurrence, Retrospective Studies, Sweden, Tissue Donors, Transplantation; Autologous, Transplantation; Homologous
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-92960DOI: 10.1038/sj.bmt.1704974PubMedID: 15834433OAI: oai:DiVA.org:uu-92960DiVA: diva2:166293
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2013-07-04Bibliographically approved
In thesis
1. Acute Lymphoblastic Leukaemia in Adult Patients: Studies of Prognostic Factors, Treatment Results and in vitro Cellular Drug Resistance
Open this publication in new window or tab >>Acute Lymphoblastic Leukaemia in Adult Patients: Studies of Prognostic Factors, Treatment Results and in vitro Cellular Drug Resistance
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment results and clinical characteristics in adult acute lymphoblastic leukaemia (ALL) were evaluated regarding three issues: a new treatment with cytarabine up-front, stem cell transplantation and a comparison between adult and paediatric treatment protocols. All studies were conducted on a national basis. Furthermore, activity of imatinib was investigated by in vitro cytotoxicity assay.

The national protocol was evaluated in 153 adult ALL patients. A high complete remission rate, 86%, was achieved with 29% overall survival at 3-years. Favourable outcome was identified in patients < 40 years with precursor B phenotype and continuous complete remission was higher for precursor B compared to T-ALL.

Stem cell transplantation was evaluated in 187 patients. No differences in outcome between allogeneic and autologous transplantation were found, with the exception of Philadelphia-positive ALL, in which allogeneic transplantation was preferable. Limited chronic graft-versus-host disease (compared to none) resulted in superior disease free survival.

The paediatric NOPHO-92 and the Adult protocols were evaluated for 243 ALL-patients. Superior remission rate and survival were achieved for 10-18 year-olds treated according to the Paediatric protocol compared to both 15-25 and 25-40 year-olds treated according to the Adult protocol. Treatment protocol was a significant prognostic factor for patients aged 15-20 years.

Fluorometric Microculture Cytotoxicity Assey was used to analyze 15 tumour cell samples from ALL patients. High concordance was determined between in vitro sensitivity to imatinib and presence of BCR-ABL. Daunorubicin, prednisolone and cytarabine had the greatest benefit from a combination with imatinib.

The national adult treatment protocol’s results were consistent with international trials regarding precursor B ALL but may be under performing for T-ALL. Adolescents may benefit from treatment according to the Paediatric protocol. No difference in outcome between allogeneic and autologous stem cell transplantation was determined except for Philadelphia-positive patients, despite the indication of a graft-versus-leukaemia effect.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 54 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 30
Medicine, acute lymphoblastic leukaemia, adult, adolescent, chemotherapy, stem cell transplantation, in vitro assay, imatinib, Medicin
National Category
Dermatology and Venereal Diseases
urn:nbn:se:uu:diva-5768 (URN)91-554-6229-4 (ISBN)
Public defence
2005-05-19, Enghoffsalen, Akademiska sjukhuset, Ingång 50, Uppsala, 09:15
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2011-06-10Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Hallböök, Helene
By organisation
In the same journal
Bone Marrow Transplantation
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 230 hits
ReferencesLink to record
Permanent link

Direct link