title: Intensive therapy before or during the conditioning regimen of allogeneic marrow transplantation in adult acute lymphoblastic leukemia patients: we must choose to reduce Toxicity--a Groupe Ouest-Est d'Etude des Leucemies et Autres Maladies du Sang study.
abstract: To improve the results in the treatment of adult acute lymphoblastic leukemia patients, different strategies have been proposed. The intensification could concern the induction and early consolidation phases, the conditioning regimen before allogeneic bone marrow transplantation (alloBMT), or both. We analyzed 2 consecutive trials for adult patients in first remission and with the same prognostic features. The Leucemie Aigue Lymphoblastique Paris-Ouest-France (LALPOF) protocol proposed alloBMT with standard conditioning after a classic induction and intensified consolidation scheme; the Groupe Ouest Est des Leucemies Aigues Lymphoblastiques (GOLEAL1) protocol tested an intensified induction and consolidation course before alloBMT with a reinforced conditioning regimen. The 4-year survival rates after alloBMT for LALPOF and GOELAL1 were, respectively, 71% +/- 12% and 36% +/- 13% ( P = .009). The 4-year disease-free survival reached 75% +/- 11% in the LALPOF study and 69% +/- 13% in the GOELAL1 study ( P = .30). The toxic death rate was significantly lower in the LALPOF (2/18) than in the GOELAL1 (6/15) group. Event-free survival at 4 years was significantly higher in LALPOF than in GOELAL1: 66% +/- 11% and 35% +/- 11%, respectively ( P = .02). For adult acute lymphoblastic leukemia patients in first remission, the intensification of chemotherapy before a reinforced conditioning regimen before alloBMT may lead to an increased toxic death rate.
authors.affiliation: Hematology Department, University Hospital of Besançon, Hôpital J. Minjoz, Institut National de la Santé et de la Recherche Médicale U645, University Besançon, Establissement Français du Sang Bourgogne Franche-Comté, Besançon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Mathilde
authors.initials: M
authors.lastname: Hunault
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
authors.forename: Marc
authors.initials: M
authors.lastname: Bernard
authors.forename: Marc
authors.initials: M
authors.lastname: Renaud
authors.forename: Bernard
authors.initials: B
authors.lastname: Desablens
authors.forename: Martine
authors.initials: M
authors.lastname: Delain
authors.forename: Francis
authors.initials: F
authors.lastname: Witz
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.forename: Bernard
authors.initials: B
authors.lastname: Pignon
authors.forename: Denis
authors.initials: D
authors.lastname: Guyotat
authors.forename: Christian
authors.initials: C
authors.lastname: Berthou
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jouet
authors.forename: Phillipe
authors.initials: P
authors.lastname: Casassus
authors.forename: Norbert
authors.initials: N
authors.lastname: Ifrah
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boiron
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods / Q000401:mortality; D014184:Transplantation, Homologous