LONG-TERM FOLLOW-UP OF ADULTS WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN FIRST REMISSION TREATED WITH CHEMOTHERAPY OR BONE-MARROW TRANSPLANTATION

Objective: To determine whether the conclusions of a 1991 study, which showed that adults with acute lymphoblastic leukemia in first remissi on had similar leukemia-free survival rates when treated with chemothe rapy or HLA-identical sibling bone marrow transplantation, remain vali d after more than 4 years of additional follow-up. Design: Retrospecti ve comparison of two cohorts of patients using left-truncated Cox regr ession to adjust for differences in baseline characteristics and time to treatment. Setting and Patients: Chemotherapy recipients were 484 c onsecutive patients with acute lymphoblastic leukemia in first remissi on treated in 44 hospitals in Germany that were participating in two c onsecutive trials of the German Acute Lymphoblastic Leukemia Therapy T rials Group. Transplant recipients were 234 consecutive recipients of HLA-identical sibling bone marrow transplants for acute lymphoblastic leukemia in first remission in 98 centers, worldwide, reporting data t o the International Bone Marrow Transplant Registry. Interventions: In tensive combination chemotherapy or HLA-identical sibling bone marrow transplantation preceded by high-dose chemotherapy with or without tot al body irradiation. Measurements: Relapse, treatment-related mortalit y, and leukemia-free survival rate 9 years after first complete remiss ion. Results: The conclusions of our previous analyses were confirmed. Actuarial relapse probabilities at 9 years were 60% (95% CI, 61% to 7 0%) for chemotherapy and 30% (CI, 22% to 37%) for transplantation (P < 0.0001). The leukemia-free survival rates at 9 years were 32% (CI, 27 % to 37%) for chemotherapy and 34% (CI, 28% to 40%) for transplantatio n (P > 0.02). Conclusions: Fewer relapses but more treatment-related d eaths were seen with transplantation than with chemotherapy. Thus, leu kemia-free survival rates were similar in adults receiving transplanta tion and adults receiving chemotherapy for acute lymphoblastic leukemi a in first remission.