Transplantation for 37cases of Refractory Acute Lymphocytic Leukemia.

Objective: To explore the efficiency and toxicity of allo-geneic hematopoietic stem cell transplantation (Allo-HSCT) for refractory acute lymphocytic leukemia.

Patients and Methods: Thirty-seven patients of refractory acute lymphocytic leukemia received allo-geneic hematopoietic stem cell transplantation containing 18/37 cases from HLA-identical siblings donors, 8/37 cases from HLA-identical unrelated donors and 11/37 cases from haplo-identical donors of the mother. The tolerance, transplant related complications, survival rate were observed and analyzed. A myeloablative conditioning regimen included TBI and Cyclophosphamide. Cyclosporine A combined MTX were used to prevent graft versus host disease (GVHD) and G-CSF was administered after Allo-HSCT.

Result: All 37 patients tolerated the therapy well and Slight or moderate mucositis was happened. Nineteen patients had light abnormal liver function and two had renal disfunction lightly, one patient had epilepsy during the therapy. Fatal infection complications were occurred in 6 patients (including idiopathic pneumonia in 2 patients). Severe acute GVHD was presented in 5 patients. Chronic GVHD was occurred in 16 patients. Hemorrhagic cystitis was happened in 1 patient, and 9 patients relapsed again after transplantation. Venoocclusive liver disease, host versus graft disease, substantia alba encephalopathy, fatal hemorrhage, secondary tumor and dysphrenia were not occured. Hematopoietic reconstitution obtained on days 12 to 25(day 17 on average). In the follow-up duration of 9 to 55 months (34 months of mid position), most of these patients had a complete chimerical state. Twenty of 37 patients are alive (54.1%). Disease free survival is 48.6%.

Conclusion: Allo-HSCT is an effective therapy in the treatment of refractory acute lymphocytic leukemia. Relapse again after transplantation, fatal infection, and severe acute GVHD are the main reasons of failure.