title: Management of adult patients with acute lymphoblastic leukemia in first complete remission: systematic review and meta-analysis.
abstract: BACKGROUND
  The optimal postremission therapy in adults with acute lymphoblastic leukemia (ALL) is still a matter of debate. The objective of this study was to compare the various potential therapeutic options for patients who achieved first complete remission.
  
  
  METHODS
  The authors conducted a systematic review and meta-analysis of randomized trials, including patients with standard-risk (SR) All and high-risk (HR) ALL who received first postremission therapy. Outcomes assessed were all-cause mortality (ACM), disease recurrence (relapse), and nonrelapse mortality (NRM). Relative risks (RRs) with 95% confidence intervals (CIs) were estimated and pooled.
  
  
  RESULTS
  Overall, there was a significant reduction in ACM in the allogenic stem cell transplantation (alloSCT) arm (RR, 0.88; 95% CI, 0.8-0.97) compared with autologous stem cell transplantation (ASCT) or chemotherapy. Subgroup analyses revealed a similar pattern among SR patients (RR, 0.8; 95% CI, 0.68-0.94) but a nonsignificant advantage for alloSCT among HR patients (RR, 0.88; 95% CI, 0.76-1.01). There was an increase in NRM (RR, 2.99; 95% CI, 1.37-6.53) and a decrease in the relapse rate in the alloSCT arm (RR, 0.52; 95% CI, 0.33-0.83). There was no difference in ACM or the relapse rate between the ASCT and chemotherapy arms.
  
  
  CONCLUSIONS
  Overall, alloSCT was superior to ASCT or chemotherapy for patients with ALL in first complete remission. The survival advantage was of greater statistical significance for patients with SR ALL than for patients with HR ALL.
authors.affiliation: Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.forename: Liat
authors.initials: L
authors.lastname: Vidal
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
authors.forename: Isaac
authors.initials: I
authors.lastname: Ben-Bassat
authors.forename: Ofer
authors.initials: O
authors.lastname: Shpilberg
authors.forename: Pia
authors.initials: P
authors.lastname: Raanani
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012074:Remission Induction