Myeloablative allogeneic versus autologous stem cell transplantation in adult patients with acute lymphoblastic leukemia in first remission: a prospective sibling donor versus no-donor comparison.
While commonly accepted in poor-risk acute lymphoblastic leukemia (ALL), the role of allogeneic hematopoietic stem cell transplantation (allo-SCT) is still disputed in adult patients with standard-risk ALL. We evaluated outcome of patients with ALL in first complete remission (CR1), according to a sibling donor versus no-donor comparison. Eligible patients (433) were entered in 2 consecutive, prospective studies, of whom 288 (67%) were younger than 55 years, in CR1, and eligible to receive consolidation by either an autologous SCT or an allo-SCT. Allo-SCT was performed in 91 of 96 patients with a compatible sibling donor. Cumulative incidences of relapse at 5 years were, respectively, 24 and 55% for patients with a donor versus those without a donor (hazard ratio [HR], 0.37; 0.23-0.60; P < .001). Nonrelapse mortality estimated 16% (+/- 4) at 5 years after allo-SCT. As a result, disease-free survival (DFS) at 5 years was significantly better in the donor group: 60 versus 42% in the no-donor group (HR: 0.60; 0.41-0.89; P = .01). After risk-group analysis, improved outcome was more pronounced in standard-risk patients with a donor, who experienced an overall survival of 69% at 5 years (P = .05). In conclusion, standard-risk ALL patients with a sibling donor may show favorable survival following SCT, due to both a strong reduction of relapse and a modest nonrelapse mortality. This trial is registered with http://www.trialregister.nl under trial ID NTR228.
Cornelissen
Jan J
JJ
Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands. j.cornelissen@erasmusmc.nl
van der Holt
Bronno
B
Verhoef
Gregor E G
GE
van't Veer
Mars B
MB
van Oers
Marinus H J
MH
Schouten
Harry C
HC
Ossenkoppele
Gert
G
Sonneveld
Pieter
P
Maertens
Johan
J
van Marwijk Kooy
Marinus
M
Schaafsma
Martijn R
MR
Wijermans
Pierre W
PW
Biesma
Douwe H
DH
Wittebol
Shulamit
S
Voogt
Paul J
PJ
Baars
Joke W
JW
Zachée
Pierre
P
Verdonck
Leo F
LF
Löwenberg
Bob
B
Dekker
Adriaan W
AW
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D035781:Siblings; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents