title: 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.
authors.affiliation: Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Dhédin
authors.forename: H
authors.initials: H
authors.lastname: Dombret
authors.forename: X
authors.initials: X
authors.lastname: Thomas
authors.forename: V
authors.initials: V
authors.lastname: Lhéritier
authors.forename: J-M
authors.initials: JM
authors.lastname: Boiron
authors.forename: F
authors.initials: F
authors.lastname: Rigal-Huguet
authors.forename: N
authors.initials: N
authors.lastname: Vey
authors.forename: M
authors.initials: M
authors.lastname: Kuentz
authors.forename: O
authors.initials: O
authors.lastname: Reman
authors.forename: F
authors.initials: F
authors.lastname: Witz
authors.forename: A
authors.initials: A
authors.lastname: Delannoy
authors.forename: T
authors.initials: T
authors.lastname: Kovacsovics
authors.forename: K
authors.initials: K
authors.lastname: Bradstock
authors.forename: C
authors.initials: C
authors.lastname: Charrin
authors.forename: C
authors.initials: C
authors.lastname: Boucheix
authors.forename: J
authors.initials: J
authors.lastname: Gabert
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.forename: D
authors.initials: D
authors.lastname: Fière
authors.forename: J-P
authors.initials: JP
authors.lastname: Vernant
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D014182:Transplantation, Autologous