C. Sebban et al., ALLOGENEIC BONE-MARROW TRANSPLANTATION IN ADULT ACUTE LYMPHOBLASTIC-LEUKEMIA IN FIRST COMPLETE REMISSION - A COMPARATIVE-STUDY, Journal of clinical oncology, 12(12), 1994, pp. 2580-2587
Purpose: Optimal postremission therapy remains controversial in adult
patients with acute lymphoblastic leukemia (ALL). In a large multicent
ric 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 eligibil
ity requirements were as follows: (1) inclusion in LALA87 trial, (2) c
omplete response to induction or salvage therapy, (3) age 15 to 40 yea
rs, and (4) at least one potential sibling donor. Patients with an HLA
-identical sibling were assigned to the BMT group, while patients with
out a sibling donor constituted the control group. Allogeneic transpla
ntation was scheduled for patients in the BMT group; in the control gr
oup, patients were randomly allocated to receive chemotherapy or autol
ogous transplantation. Results: Of 284 eligible points, 257 entered th
e study: 116 were allocated to the BMT group and 141 to the control gr
oup. The 5-year survival rates were not statistically significantly di
fferent between the two groups. When only patients with high-risk ALL
were considered (those with [1] Philadelphia chromosome [Phl] ALL, [2]
null or undifferentiated ALL, or [3] c-ALL with either age greeter th
en 35 years or WBC count > 30 x 10(9)/L or time to achieve complete re
mission > 4 weeks), overall survival (P =.03) and disease-free-surviva
l (P =.01) were better for the BMI group compared with the control gro
up (5-year overall survival rates, 44% v 20%; 5-year disease-free surv
ival rates, 39% v 14%). Conclusion: Allogeneic transplantation does no
t improve survival in patients with standard-risk ALL and should be re
commended only for patients with adverse prognostic factors. (C) 1994
by American Society of Clinical Oncology.