title: The role of hematopoietic cell transplantation in adult ALL: clinical equipoise persists.
abstract: Adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) may be treated either with ongoing systemic chemotherapy or with allogeneic hematopoietic cell transplantation (alloHCT). Despite the presence of phase III trials to support clinical decision-making, we hypothesized that physicians who treat adult ALL would demonstrate wide practice variation. Canadian hematologists who treat ALL were surveyed electronically. Overall, 69 of 173 physicians responded (40%). There was high agreement with offering alloHCT for ALL with high-risk cytogenetics or induction failure after a single chemotherapy cycle. However, only a minority of respondents felt that age >35 years was an indication for alloHCT in CR1. Almost all respondents (96%) felt that a well-matched unrelated donor was an acceptable alternative to a sibling donor. There was uncertainty about the role of cord blood (53% agree) and the utility of reduced intensity conditioning HCT (41% agree). In contrast to the results of the MRC/ECOG study, respondents considered alloHCT to be particularly helpful in high-risk patients. Consensus was lacking on the use of cord blood, RIC alloHCT, and the application of MRD. Equipoise exists on the role of alloHCT in CR1 in ALL, suggesting that further trials in this area are required.
authors: Section of Haematology/Oncology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada. Electronic address: Kristjan.paulson@cancercare.mb.ca.
authors: K
authors: K
authors: Paulson
authors: Section of Haematology/Oncology, Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada.
authors: D
authors: D
authors: Szwajcer
authors: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
authors: C B
authors: CB
authors: Raymond
authors: Division of Medical Oncology&Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: M D
authors: MD
authors: Seftel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D010820:Physicians; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011364:Professional Practice / Q000706:statistics & numerical data; D012074:Remission Induction; D035781:Siblings; D014184:Transplantation, Homologous; D061349:Unrelated Donors
keywords: Acute lymphoblastic leukemia; Evidence based medicine; Hematopoietic stem cell transplant