Outcome of treatment in adults with acute lymphoblastic leukemia: analysis of the LALA-94 trial.
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.
Thomas
Xavier
X
Service d'Hématologie, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France. xavier.thomas@chu-lyon.fr
Boiron
Jean-Michel
JM
Huguet
Françoise
F
Dombret
Hervé
H
Bradstock
Ken
K
Vey
Norbert
N
Kovacsovics
Tibor
T
Delannoy
André
A
Fegueux
Nathalie
N
Fenaux
Pierre
P
Stamatoullas
Aspasia
A
Vernant
Jean-Paul
JP
Tournilhac
Olivier
O
Buzyn
Agnès
A
Reman
Oumedaly
O
Charrin
Christiane
C
Boucheix
Claude
C
Gabert
Jean
J
Lhéritier
Véronique
V
Fiere
Denis
D
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