title: 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.
abstract: 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.
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands. j.cornelissen@erasmusmc.nl
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.forename: Bronno
authors.initials: B
authors.lastname: van der Holt
authors.forename: Gregor E G
authors.initials: GE
authors.lastname: Verhoef
authors.forename: Mars B
authors.initials: MB
authors.lastname: van't Veer
authors.forename: Marinus H J
authors.initials: MH
authors.lastname: van Oers
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Gert
authors.initials: G
authors.lastname: Ossenkoppele
authors.forename: Pieter
authors.initials: P
authors.lastname: Sonneveld
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Marinus
authors.initials: M
authors.lastname: van Marwijk Kooy
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Schaafsma
authors.forename: Pierre W
authors.initials: PW
authors.lastname: Wijermans
authors.forename: Douwe H
authors.initials: DH
authors.lastname: Biesma
authors.forename: Shulamit
authors.initials: S
authors.lastname: Wittebol
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Voogt
authors.forename: Joke W
authors.initials: JW
authors.lastname: Baars
authors.forename: Pierre
authors.initials: P
authors.lastname: Zachée
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: Bob
authors.initials: B
authors.lastname: Löwenberg
authors.forename: Adriaan W
authors.initials: AW
authors.lastname: Dekker
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents