In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: Final results of the International ALL Trial (MRC UKALLXII/ECOG E2993)

Anthony H. Goldstone, Susan M. Richards, Hillard M. Lazarus, Martin S. Tallman, Georgina Buck, Adele K. Fielding, Alan K. Burnett, Raj Chopra, Peter H. Wiernik, Letizia Foroni, Elisabeth Paietta, Mark R. Litzow, David I. Marks, Jill Durrant, Andrew McMillan, Ian M. Franklin, Selina Luger, Niculae Ciobanu, Jacob M. Rowe

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Abstract

An international collaboration was set up to prospectively evaluate the role of allogeneic transplantation for adults with acute lymphoblastic leukemia (ALL) and compare autologous transplantation with standard chemotherapy. Patients received 2 phases of induction and, if in remission, were assigned to allogeneic transplantation if they had a compatible sibling donor. Other patients were randomized to chemotherapy for 2.5 years versus an autologous transplantation. A donor versus no-donor analysis showed that Philadelphia chromosome-negative patients with a donor had a 5-year improved overall survival (OS), 53% versus 45% (P = .01), and the relapse rate was significantly lower (P ≤ .001). The survival difference was significant in standard-risk patients, but not in high-risk patients with a high nonrelapse mortality rate in the high-risk donor group. Patients randomized to chemotherapy had a higher 5-year OS (46%) than those randomized to autologous transplantation (37%; P = .03). Matched related allogeneic transplantations for ALL in first complete remission provide the most potent antileukemic therapy and considerable survival benefit for standard-risk patients. However, the transplantation-related mortality for high-risk older patients was unacceptably high and abrogated the reduction in relapse risk. There is no evidence that a single autologous transplantation can replace consolidation/maintenance in any risk group. This study is registered at http:// clinicaltrials.gov as NCT00002514.

Original languageEnglish (US)
Pages (from-to)1827-1833
Number of pages7
JournalBlood
Volume111
Issue number4
DOIs
StatePublished - Feb 15 2008

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Goldstone, A. H., Richards, S. M., Lazarus, H. M., Tallman, M. S., Buck, G., Fielding, A. K., Burnett, A. K., Chopra, R., Wiernik, P. H., Foroni, L., Paietta, E., Litzow, M. R., Marks, D. I., Durrant, J., McMillan, A., Franklin, I. M., Luger, S., Ciobanu, N., & Rowe, J. M. (2008). In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: Final results of the International ALL Trial (MRC UKALLXII/ECOG E2993). Blood, 111(4), 1827-1833. https://doi.org/10.1182/blood-2007-10-116582