In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993).
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| Abstract |
An international collaboration was set up to prospectively evaluate the role of allogeneic transplantation for adults with acute lymphoblastic leukemia (ALL) and compare autologous transplantation with standard chemotherapy. Patients received 2 phases of induction and, if in remission, were assigned to allogeneic transplantation if they had a compatible sibling donor. Other patients were randomized to chemotherapy for 2.5 years versus an autologous transplantation. A donor versus no-donor analysis showed that Philadelphia chromosome-negative patients with a donor had a 5-year improved overall survival (OS), 53% versus 45% (P = .01), and the relapse rate was significantly lower (P < or = .001). The survival difference was significant in standard-risk patients, but not in high-risk patients with a high nonrelapse mortality rate in the high-risk donor group. Patients randomized to chemotherapy had a higher 5-year OS (46%) than those randomized to autologous transplantation (37%; P = .03). Matched related allogeneic transplantations for ALL in first complete remission provide the most potent antileukemic therapy and considerable survival benefit for standard-risk patients. However, the transplantation-related mortality for high-risk older patients was unacceptably high and abrogated the reduction in relapse risk. There is no evidence that a single autologous transplantation can replace consolidation/maintenance in any risk group. This study is registered at http://clinicaltrials.gov as NCT00002514.
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| Authors | Anthony H Goldstone, Susan M Richards, Hillard M Lazarus, Martin S Tallman, Georgina Buck, Adele K Fielding, Alan K Burnett, Raj Chopra, Peter H Wiernik, Letizia Foroni, Elisabeth Paietta, Mark R Litzow, David I Marks, Jill Durrant, Andrew McMillan, Ian M Franklin, Selina Luger, Niculae Ciobanu, Jacob M Rowe |
| Journal | Blood (Blood) Vol. 111 Issue 4 Pg. 1827-33 (Feb 15 2008) ISSN: 0006-4971 [Print] United States |
| PMID | 18048644 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial) |
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