By Frederick R. Appelbaum MD (auth.), Mary J. Laughlin MD, Hillard M. Lazarus MD (eds.)
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Extra info for Allogeneic Stem Cell Transplantation: Clinical Research and Practice
Mehta J, Powles R, Horton C, et al. Bone marrow transplantation for primary refractory acute leukemia. Bone Marrow Transplant 1994;14:415–418. 68. Biggs JC, Horowitz MM, Gale RP, et al. Bone marrow transplants may cure patients with acute leukemia never achieving remission with chemotherapy. Blood 1992;80:1090–1093. 69. Fung HC, O’Donnell M, Popplewell L, et al. Allogeneic stem cell transplantation (SCT) for patients with primary refractory acute myelogenous leukemia (AML): impact of cytogenetic risk group on the transplant outcome.
Phase II studies are ongoing in AML with this approach, but the early data would suggest that incorporation of the radioimmunoconjugate into the preparative regimen is tolerable and will require further studies to determine the impact on preventing relapse in the various subgroups of AML. In addition, the optimal use of chemotherapy as part of the preparative regimen is receiving increasing attention based on observations concerning the different pharmacokinetic and 24 Part II / Historic Indications: Allogeneic Transplantation pharmacogenetic disposition of these agents in individual patients undergoing transplantation.
Using this intensive but short-duration chemotherapeutic approach, these high-risk patients now achieve CR in 70– 80% of cases and have DFS approaching 50%. As described above, and discussed in detail below, ALL patients with a t(9;22) (q34;q11) have fared very poorly with standard ALL chemotherapy, but can achieve prolonged DFS when allogeneic SCT approaches are used. A number of investigators have combined these prognostic factors to predict the efficacy of the planned chemotherapy and to assess the potential use of allogeneic transplantation for patients with ALL.