title: Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial.
abstract: OBJECTIVE
  We analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia (ALL), and re-evaluated stem-cell transplantation (SCT) for high-risk ALL.
  
  
  METHODS
  A total of 922 adult patients entered onto the trial according to risk groups: standard-risk ALL (group 1), high-risk ALL (group 2), Philadelphia chromosome-positive ALL (group 3), and CNS-positive ALL (group 4). All received a standard four-drug/4-week induction course. Patients from group 1 who achieved a complete remission (CR) after one course of induction therapy were randomly assigned between intensive and less intensive postremission chemotherapy, whereas those who achieved CR after salvage therapy were then included in group 2. Patients in groups 2, 3, and 4 with an HLA-identical sibling were assigned to allogeneic SCT. In groups 3 and 4, autologous SCT was offered to all other patients, whereas in group 2 they were randomly assigned between chemotherapy and autologous SCT.
  
  
  RESULTS
  Overall, 771 patients achieved CR (84%). Median disease-free survival (DFS) was 17.5 months, with 3-year DFS at 37%. In group 1, the 3-year DFS rate was 41%, with no difference between arms of postremission randomization. In groups 2 and 4, the 3-year DFS rates were 38% and 44%, respectively. In group 2, autologous SCT and chemotherapy resulted in comparable median DFS. Patients with an HLA-matched sibling (groups 2 and 4) had improved DFS. Three-year DFS was 24% in group 3.
  
  
  CONCLUSIONS
  Allogeneic SCT improved DFS in high-risk ALL in the first CR. Autologous SCT did not confer a significant benefit over chemotherapy for high-risk ALL.
authors.affiliation: Service d'Hématologie, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France. xavier.thomas@chu-lyon.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
authors.forename: Françoise
authors.initials: F
authors.lastname: Huguet
authors.forename: Hervé
authors.initials: H
authors.lastname: Dombret
authors.forename: Ken
authors.initials: K
authors.lastname: Bradstock
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.forename: Tibor
authors.initials: T
authors.lastname: Kovacsovics
authors.forename: André
authors.initials: A
authors.lastname: Delannoy
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.forename: Aspasia
authors.initials: A
authors.lastname: Stamatoullas
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Vernant
authors.forename: Olivier
authors.initials: O
authors.lastname: Tournilhac
authors.forename: Agnès
authors.initials: A
authors.lastname: Buzyn
authors.forename: Oumedaly
authors.initials: O
authors.lastname: Reman
authors.forename: Christiane
authors.initials: C
authors.lastname: Charrin
authors.forename: Claude
authors.initials: C
authors.lastname: Boucheix
authors.forename: Jean
authors.initials: J
authors.lastname: Gabert
authors.forename: Véronique
authors.initials: V
authors.lastname: Lhéritier
authors.forename: Denis
authors.initials: D
authors.lastname: Fiere
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation