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Allogeneic hematopoietic cell transplantation from alternative sources for adult Philadelphia chromosome-negative ALL: what should we choose when no HLA-matched related donor is available?

Bone Marrow Transplantation volume 48, pages 1369–1376 (2013)Cite this article

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Abstract

The best outcome for patients with Ph chromosome-negative ALL (Ph(−) ALL) can be obtained by HLA-matched related donor (mRD) allogeneic hematopoietic cell transplantation (allo-HCT) in first CR. However, only 30% of patients have a mRD. Three alternative sources, unrelated donor (URD), cord blood, and haploidentical related donor (haplo-RD), are available. URD allo-HCT is an old-established alternative source, and recent data have shown that URD allo-HCT can result in OS comparable with that with mRD allo-HCT for patients with Ph(−) ALL in first CR (OS at 4 years: mRD 65% vs URD 62%). Unrelated cord blood transplantation can also be indicated for patients with Ph(−) ALL in first CR (OS at 4 years: 57%), especially for young patients without an HLA-matched URD or patients who are in urgent need for allo-HCT. Limited data for haplo-RD allo-HCT for ALL showed utility in CR (OS at 3 years: up to 65%) but a survival rate of only 5–7% in non-CR. As there are no confirmed data about the utility of allo-HCT from an alternative source for adolescent and young adults who are eligible for pediatric protocols or for elderly patients with reduced-intensity conditioning. Further investigation, including investigation of minimal residual disease detection, may reveal subgroups of patients who can receive benefits from allo-HCT. Selection of the best source based on the patient status and appropriate timing is warranted.

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Acknowledgements

This study was supported, in part, by a Japan Leukemia Research Fund grant, a Grant-in-Aid from the Ministry of Health, Labor and Welfare of Japan, and a Japanese Grant-in-Aid for Scientific Research.

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  1. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    S Nishiwaki

  2. Department of HSCT Data Management/Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

  3. Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    J Tanaka

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Nishiwaki, S., Atsuta, Y. & Tanaka, J. Allogeneic hematopoietic cell transplantation from alternative sources for adult Philadelphia chromosome-negative ALL: what should we choose when no HLA-matched related donor is available?. Bone Marrow Transplant 48, 1369–1376 (2013). https://doi.org/10.1038/bmt.2013.20

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