Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial.
Various transplantation strategies have been designed to improve the poor prognosis of adult (ages 15 to 60 years) acute lymphoblastic leukemia (ALL). The GOELAL02 trial evaluated the impact of early allogeneic bone marrow transplantation (alloBMT) or delayed unpurged autologous stem cell transplantation (ASCT) for patients who had no human leukocyte antigen (HLA)-matched sibling donor or who were older than 50 years. Inclusion criteria included at least one of the following: age older than 35 years; non-T-ALL; leukocytosis greater than 30 x 10(9)/L; t(9;22), t(4;11), or t(1; 19); or failure to achieve complete remission (CR) after one induction course. Among 198 patients, the median age was 33 years. The CR rate was 80% with vincristine, idarubicine, L-asparaginase, and randomized intravenous injection or oral steroids (P = nonsignificant [ns]). AlloBMT was performed after 2 consolidation courses while ASCT was delayed after 1 additional reinduction. Intensified conditioning regimen before transplantation included etoposide, cyclophosphamide, and total body irradiation (TBI). Median follow-up was 5.1 years. The median overall survival (OS) was 29 months, with a 6-year OS of 41%. On an intent-to-treat analysis for patients younger than 50 years, alloBMT significantly improved the 6-year OS (75% versus 40% after ASCT; P = .0027). Randomized interferon-alpha maintenance had no effect on relapse or survival after ASCT. In conclusion, the outcome of adult ALL is better after early alloBMT than after delayed ASCT.
Hunault
Mathilde
M
Hematology Department, University of Angers, France.
Harousseau
Jean-Luc
JL
Delain
Martine
M
Truchan-Graczyk
Malgorzata
M
Cahn
Jean-Yves
JY
Witz
Francis
F
Lamy
Thierry
T
Pignon
Bernard
B
Jouet
Jean-Pierre
JP
Garidi
Reda
R
Caillot
Denis
D
Berthou
Christian
C
Guyotat
Denis
D
Sadoun
Alain
A
Sotto
Jean-Jacques
JJ
Lioure
Bruno
B
Casassus
Philippe
P
Solal-Celigny
Philippe
P
Stalnikiewicz
Laure
L
Audhuy
Bruno
B
Blanchet
Odile
O
Baranger
Laurence
L
Béné
Marie-Christine
MC
Ifrah
Norbert
N
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001215:Asparaginase / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003630:Daunorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D000970:Antineoplastic Agents; D016898:Interferon-alpha; D014750:Vincristine; C054440:idarubicinol; D001215:Asparaginase; D003630:Daunorubicin