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Prepublished online as a Blood First Edition Paper on May 13, 2002; DOI 10.1182/blood-2002-03-0776.
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Blood, 1 September 2002, Vol. 100, No. 5, pp. 1641-1647
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
The role of posttransplantation maintenance chemotherapy in
improving the outcome of autotransplantation in adult acute
lymphoblastic leukemia
Ray Powles,
Bhawna Sirohi,
Jennifer Treleaven,
Samar Kulkarni,
Diana Tait,
Seema Singhal, and
Jayesh Mehta
From the Leukaemia Unit, The Royal Marsden Hospital,
Surrey, United Kingdom.
Extending the principle of conventional acute lymphoblastic
leukemia (ALL) therapy to transplantation, 77 adult patients receiving autografts in first remission after melphalan with or without total
body irradiation were scheduled to receive 6-mercaptopurine (6MP),
methotrexate (MTX), and vincristine-prednisone (VP) for 2 years after
transplantation to reduce relapse. Seventy-one percent of patients
received 6MP, 57% received MTX, and 38% received VP. Thirty patients
had a relapse at 1.5 to 80 months (median, 12.5 months), 15 in the
first year and 7 beyond 3 years. The cumulative incidence of relapse at
10 years was 42% (95% CI, 31%-55%). The 10-year probabilities of
disease-free survival (DFS) and overall (OS) survival were 50% (95%
CI, 38%-62%) and 53% (95% CI, 41%-65%), respectively. Age older
than 30 years, more than 4 weeks to attain remission, and high-risk
karyotypes, for example, t(9;22) or t(4;11), were adverse features
contributing to the identification of 3 prognostic risk groups with 0, 1, and 2 adverse features, respectively: standard (47%), intermediate
(36%), and high (17%). The 10-year cumulative incidences of relapse
(20%, 48%, 85%; P < .0001) and probabilities of DFS
(72%, 41%, 10%; P = .0003) were significantly different among these groups. In Cox analysis of the 71 patients alive
and well 120 days after transplantation, those receiving 2 or 3 maintenance chemotherapy agents had significantly lower relapse rates
and superior DFS compared with those receiving 0 or 1 agent. Our data
suggest that maintenance chemotherapy improves the outcome of patients
with ALL undergoing autografting. However, it is unlikely that
autograft-based strategies are optimal for the high-risk group of
patients who should be considered for alternative-donor allograft procedures.
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M. Hunault, J.-L. Harousseau, M. Delain, M. Truchan-Graczyk, J.-Y. Cahn, F. Witz, T. Lamy, B. Pignon, J.-P. Jouet, R. Garidi, et al.
Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial
Blood,
November 15, 2004;
104(10):
3028 - 3037.
[Abstract]
[Full Text]
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