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Autologous stem cell transplantation in adults with acute lymphoblastic leukemia in first complete remission: analysis of the LALA-85, -87 and -94 trials.

Abstract
To evaluate the results of autologous stem cell transplantation (ASCT) in a large population of adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR), we performed an individual data-based overview of the last three trials from the LALA group. Overall, 349 patients with ALL prospectively randomized in the consecutive LALA-85, -87, and -94 trials to receive either ASCT or chemotherapy as post-CR treatment were analyzed. Eligibility criteria were 15-50-year-old patients without sibling donors in both LALA-85/87 trials and 15-55-year-old patients with high-risk ALL and no sibling donors in the LALA-94 trial. Intent-to-treat analysis, which compared 175 patients from the ASCT arm to 174 patients from the chemotherapy arm, showed that ASCT was associated with a lower cumulative incidence of relapse (66 vs 78% at 10 years; P=0.05), without significant gain in disease-free or overall survival. Despite a possible lack of statistical power, a nested case-control analysis performed in 85 patient pairs adjusted for time to transplant and prognostic covariates confirmed these intent-to-treat results in patients actually transplanted. Of interest, the reduced relapse risk after ASCT translated in better disease-free survival in the 300 rapid responders who reached CR after the first induction course.
AuthorsN Dhédin, H Dombret, X Thomas, V Lhéritier, J-M Boiron, F Rigal-Huguet, N Vey, M Kuentz, O Reman, F Witz, A Delannoy, T Kovacsovics, K Bradstock, C Charrin, C Boucheix, J Gabert, D Blaise, D Fière, J-P Vernant
JournalLeukemia (Leukemia) Vol. 20 Issue 2 Pg. 336-44 (Feb 2006) ISSN: 0887-6924 [Print] England
PMID16357838 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Topics
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Peripheral Blood Stem Cell Transplantation
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma (diagnosis, drug therapy, therapy)
  • Prospective Studies
  • Recurrence
  • Remission Induction
  • Risk Factors
  • Survival Analysis
  • Transplantation, Autologous

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