1. Allogeneic bone marrow transplantation in adult acute lymphoblastic leukemia in first complete remission: a comparative study. French Group of Therapy of Adult Acute Lymphoblastic Leukemia
- Author
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Eric Lepage, M. Attal, Laurent Sutton, Mauricette Michallet, Dominique Maraninchi, Josy Reiffers, Eliane Gluckman, Catherine Sebban, J P Vernant, and Evelyne Racadot
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Allogeneic transplantation ,Adolescent ,medicine.medical_treatment ,Salvage therapy ,Transplantation, Autologous ,Acute lymphocytic leukemia ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Transplantation, Homologous ,Autologous transplantation ,Cyclophosphamide ,Bone Marrow Transplantation ,Chemotherapy ,business.industry ,Histocompatibility Testing ,Remission Induction ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Prognosis ,medicine.disease ,Surgery ,Survival Rate ,Transplantation ,medicine.anatomical_structure ,Oncology ,Vincristine ,Adult Acute Lymphoblastic Leukemia ,Prednisone ,Female ,Bone marrow ,business - Abstract
PURPOSE Optimal postremission therapy remains controversial in adult patients with acute lymphoblastic leukemia (ALL). In a large multicentric trial (LALA87), we compared allogeneic bone marrow transplantation (BMT) with other postremission therapies (chemotherapy or autologous transplantation) using the result of the human leukocyte antigen (HLA) typing as a random allocation. PATIENTS AND METHODS Patient eligibility requirements were as follows: (1) inclusion in LALA87 trial, (2) complete response to induction or salvage therapy, (3) age 15 to 40 years, and (4) at least one potential sibling donor. Patients with an HLA-identical sibling were assigned to the BMT group, while patients without a sibling donor constituted the control group. Allogeneic transplantation was scheduled for patients in the BMT group; in the control group, patients were randomly allocated to receive chemotherapy or autologous transplantation. RESULTS Of 284 eligible points, 257 entered the study: 116 were allocated to the BMT group and 141 to the control group. The 5-year survival rates were not statistically significantly different between the two groups. When only patients with high-risk ALL were considered (those with [1] Philadelphia chromosome [Ph1] ALL, [2] null or undifferentiated ALL, or [3] c-ALL with either age greater than 35 years or WBC count > 30 x 10(9)/L or time to achieve complete remission > 4 weeks), overall survival (P = .03) and disease-free-survival (P = .01) were better for the BMT group compared with the control group (5-year overall survival rates, 44% v 20%; 5-year disease-free survival rates, 39% v 14%). CONCLUSION Allogeneic transplantation does not improve survival in patients with standard-risk ALL and should be recommended only for patients with adverse prognostic factors.
- Published
- 1994