We present 60 patients with refractory (n= 8) or relapsed (n= 52) adult ALL who received allogeneic hematopoietic SCT (HSCT) with (n= 41) or without (n= 19) prior reinduction chemotherapy. In our center, omission of reinduction is recommended if a suitable donor is promptly available, tumor burden is moderate and disease features suggest a highly aggressive course. Overall survival (OS) of the whole cohort at 1, 2 and 5 years was 42, 33 and 28%, respectively. Leukemia-free survival at 1, 2 and 5 years was 37, 33 and 24%. Deaths were due to relapse (n= 25), acute or chronic GVHD (n= 7), infections (n= 8) or toxicity (n= 4). Interestingly, patients who did not receive reinduction before HSCT had better outcomes than patients who received reinduction with OS at 1, 2 and 5 years being 58vs34%, 47vs25% and 47vs18%, respectively (P= 0.039). Importantly, even achievement of a second CR after reinduction was not associated with improved survival compared to patients directly proceeding to HSCT. We conclude that patients who undergo HSCT for refractory or relapsed ALL can achieve long-term survival. In selected patients, reinduction chemotherapy can be omitted if immediate HSCT is feasible.
Bone Marrow Transplantation (2008) 42, 791-798; doi:10.1038/bmt.2008.258; published online 18 August 2008