For people with acute lymphoblastic leukemia (ALL) who are at high risk of relapse or who have already relapsed, a bone marrow or cord blood transplant (also called a BMT) may be a treatment option. A transplant has risks of serious complications, but may offer some patients with ALL the best chance for a long-term remission of their disease.
This page provides some data on ALL patients' outcomes after transplant. For an overview of ALL and how it may be treated, see Acute Lymphoblastic Leukemia (ALL).
The National Marrow Donor Program® (NMDP) and its research arm, the Center for International Blood and Marrow Transplant Research® (CIBMTR), collect and study data to learn how to improve patient outcomes. The NMDP also operates Be The Match®.
It is a good idea to ask your doctor for help interpreting these data and any other survival outcomes data you find. Your doctor can provide context for these data and discuss your specific situation with you. For more things to consider, see
Understanding Survival Outcomes Data.
ALL transplant survival data
Figures 1-5 show outcomes for allogeneic transplants, which use blood-forming cells from a family member or unrelated donor or cord blood unit.
For allogeneic transplants using adult donors, the blood-forming cells can be collected from the donor’s marrow or from the bloodstream (peripheral blood stem cells, or PBSC). The figures below showing data from the NMDP state whether patients received marrow or PBSC.
Though the outcomes for marrow and PBSC transplants may appear different below, there could be many reasons for this. For example, the patient groups may not have the same risk factors (such as age or past treatments). Doctors are still trying to find out whether one works better than the other.
Figure 1.
Probability of Survival after HLA-Identical Sibling Transplants for ALL, Age < 20 Years, 2000-2010, by disease status. (CIBMTR data)
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Figure 2.
Probability of Survival after HLA-Identical Sibling Transplants for ALL, Age ≥ 20 Years, 2000-2010, by disease status. (CIBMTR data)
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Figure 3.
Acute Lymphoblastic Leukemia: Survival of pediatric (age <18 years) marrow recipients, by disease stage, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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Figure 4.
Acute Lymphoblastic Leukemia: Survival of adult (age ≥18 years) marrow recipients, by disease stage, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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Figure 5.
Acute Lymphoblastic Leukemia: Survival of adult (age ≥18 years) PBSC recipients, by disease stage, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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Status of the disease at time of transplant
In general, transplants in first remission have a better chance of a good outcome than transplants received later or when the disease is not in remission. The data above show that for adults, a transplant in first complete remission or early disease offers a higher likelihood of 5-year survival compared to transplants for patients in second remission or with advanced disease (Figures 2, 4 and 5).
For children, the data show that likelihood of 5-year survival is increased for patients who receive a transplant in early or intermediate disease or first or second complete remission compared to patients with advanced disease at the time of transplant (Figures 1 and 3).
Outcomes for ALL patients with the Philadelphia chromosome
Clinical studies have found that for children and adults who have ALL with the Philadelphia chromosome (Ph+ ALL) and some other high-risk factors, an allogeneic transplant in first remission offers the best chance for a good outcome. One study that compared results for children with Ph+ ALL who were treated at several centers between 1986 and 1996 found:
- Treatment with chemotherapy resulted in a 25% rate of survival without relapse (disease-free survival).
- Treatment with an allogeneic transplant using a matching sibling donor resulted in a 65% disease-free survival rate. [1]
For adults with Ph+ ALL, treatment with chemotherapy has resulted in survival rates of 20% or lower. Studies in which adults with Ph+ ALL were treated with allogeneic transplant have reported survival rates of 30% to 50%. [2]
Information to share with your doctor
The Physician Resources section of this Web site includes information for doctors about timing and outcomes of transplants for ALL, as well as references to related medical journal articles. You may want to share some of this information with your doctor.
References
- Aricò M, Valsecchi MG, Camitta B, et al. Outcome of treatment in children with Philadelphia chromosome-positive acute lymphoblastic leukemia. N Engl J Med. 2000; 342(14):998-1006.
http://content.nejm.org/cgi/content/full/342/14/998
- Avivi I, Rowe JM, Goldstone AH. Stem cell transplantation in adult ALL patients. Best Pract Res Clin Haematol. 2002; 15(4):653-674.
http://dx.doi.org/10.1053/beha.2003.0232
Contributing editors
C. F. LeMaistre, M.D., Southwest Texas Methodist Hospital, San Antonio, Texas
Paul Shaughnessy, M.D., Texas Transplant Institute, San Antonio, Texas
Anthony S. Stein, M.D., City of Hope National Medical Center, Duarte, Calif.