ROLE OF ALLOGENEIC BONE-MARROW TRANSPLANTATION IN ADOLESCENT OR ADULTPATIENTS WITH ACUTE LYMPHOBLASTIC-LEUKEMIA OR LYMPHOBLASTIC LYMPHOMA IN FIRST REMISSION

Sixty-nine adolescents and adults 15-51 years of age with untreated ac ute lymphoblastic leukaemia (ALL, 54 patients) or lymphoblastic lympho ma (LL, 15 patients) were referred for intensive antileukaemic therapy , Patients were treated according to one of two protocols, Both includ ed induction and consolidation with vincristine, prednisone, daunorubi cin, cyclophosphamide, Ara C and asparaginase, Fifty-eight patients ac hieved complete remission within 8 weeks of chemotherapy, One addition al patient entered remission after allogeneic BMT, Altogether 86% of t he patients achieved CR, Thirty-three patients are alive, correspondin g to an actuarial survival of 48 +/- 6% at 5 years after start of ther apy, Survival from time of achievement of CR is 53 +/- 7% at 5 years a nd disease-free survival (DFS) is 52 +/- 7%, Consolidation treatment w as given to all patients except one, An HLA-identical sibling was iden tified for 30 patients (45%), Twenty-two patients were scheduled to be transplanted with marrow from an HLA-identical sibling, The survival and DFS in these 22 patients was 58 +/- 11% at 5 years, DFS was not si gnificantly different compared with the DFS of the eight patients who received an auto-BMT and the 26 patients treated with maintenance chem otherapy. DFS at 5 years was 63 +/- 17% and 40 +/- 10%, respectively, We also evaluated the influence of the presence of an HLA-identical si bling on the treatment outcome of all patients alive 12 weeks after in itiation of remission-induction therapy, Survival at 5 years was 41 +/ - 9% in the group of 33 patients without donor and 59 +/- 9% in the gr oup of 30 patients with a donor (p = 0.18), Survival at 5 years in the high-risk group of 22 patients without a donor was 32 +/- 10% and 59 +/- 10% in the group of 25 patients with a donor (p = 0.04), DFS at 5 years was significantly (p < 0.05) better in the high-risk group with a donor (62 +/- 10%) compared with the DFS of the group without a dono r (29 +/- 12%), Seventeen of these 25 high-risk patients underwent all ogeneic BMT, The results of this study suggest that allogeneic BMT sho uld be seriously considered during first CR for adolescent and adult p atients with high risk ALL or LL under the age of 50 years when an HLA -identical sibling is available, Ongoing prospective trials which comp are the outcome of allo-BMT with auto-BMT and intensive chemotherapy i n first CR will determine the ultimate role of BMT in patients with AL L or LL in first remission.