Abstract
Eighty-nine patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph1ALL) who were registered with the committee of stem cell transplantation (SCT) of the Japanese Society for Pediatric Hematology were analyzed. Seventy-one patients received allogeneic bone marrow transplantation (BMT) (allo), including one syngeneic BMT, 9 autologous BMTs (auto), and 9 autologous peripheral stem cell transplantations (PBSCT). Relapses occurred in 27 allos, 4 autos, and 8 PBSCTs at a median of 6 months after transplantation. Five-year event-free survival (EFS) rates for allo, auto, and PBSCT were 26.0 + 5.7%, 51.9 + 17.6%, and 0%, respectively. Patients that received PBSCTs had the worst prognosis (p < 0.01), and no significant difference of EFS between allo and auto was noted. Transplant-related mortality occurred in 19 allos and one PBSCT. The main causes of death were hepatic veno-occlusive disease, sepsis, interstitial pneumonia, and graft-versus-host disease (GVHD). Status at BMT from matched sibling donors (p < 0.02) and the occurrence of chronic GVHD (p < 0.05) significantly affected the prognosis of patients after allo BMT. Multivariate analysis indicated that the occurrence of chronic GVHD was an indepentent prognostic factor for relapse-free survival. SCT should be carried out as early as possible by a less toxic method for Ph1ALL.
