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Blood, 15 November 2004, Vol. 104, No. 10, pp. 3028-3037.
Prepublished online as a Blood First Edition Paper on July 15, 2004; DOI 10.1182/blood-2003-10-3560.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
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
Mathilde Hunault,
Jean-Luc Harousseau,
Martine Delain,
Malgorzata Truchan-Graczyk,
Jean-Yves Cahn,
Francis Witz,
Thierry Lamy,
Bernard Pignon,
Jean-Pierre Jouet,
Reda Garidi,
Denis Caillot,
Christian Berthou,
Denis Guyotat,
Alain Sadoun,
Jean-Jacques Sotto,
Bruno Lioure,
Philippe Casassus,
Philippe Solal-Celigny,
Laure Stalnikiewicz,
Bruno Audhuy,
Odile Blanchet,
Laurence Baranger,
Marie-Christine Béné, and
Norbert Ifrah, for the GOELAMS (Groupe Ouest-Est des Leucémies Aiguës et Maladies du Sang) Group
From the Hematology Department, the Molecular Biology Department, and the Cytogenetic Department of the University of Angers, Angers; the Hematology Department and the Immunology Department of the University of Nancy, Nancy; the Hematology Departments of the University of Nantes, Nantes; the University of Tours, Tours; the University of Besancon, Besancon; the University of Rennes, Rennes; the University of Reims, Reims; the University of Lille, Lille; the University of Amiens, Amiens; the University of Dijon, Dijon; the University of Brest, Brest; the University of Saint Etienne, Saint Etienne; the University of Poitiers, Poitiers; the University of Grenoble, Grenoble; the University of Strasbourg, Strasbourg; the University of Bobigny, Bobigny; the Hospital of Le Mans, Le Mans; the Hospital of Lens, Lens; and the Hospital of Colmar, Colmar, France.
Various transplantation strategies have been designed to improve the poor prognosis of adult (ages 15 to 60 years) acute lymphoblastic leukemia (ALL). The GOELAL02 trial evaluated the impact of early allogeneic bone marrow transplantation (alloBMT) or delayed unpurged autologous stem cell transplantation (ASCT) for patients who had no human leukocyte antigen (HLA)–matched sibling donor or who were older than 50 years. Inclusion criteria included at least one of the following: age older than 35 years; non–T-ALL; leukocytosis greater than 30 x 109/L; t(9;22), t(4;11), or t(1; 19); or failure to achieve complete remission (CR) after one induction course. Among 198 patients, the median age was 33 years. The CR rate was 80% with vincristine, idarubicine, L-asparaginase, and randomized intravenous injection or oral steroids (P = nonsignificant [ns]). AlloBMT was performed after 2 consolidation courses while ASCT was delayed after 1 additional reinduction. Intensified conditioning regimen before transplantation included etoposide, cyclophosphamide, and total body irradiation (TBI). Median follow-up was 5.1 years. The median overall survival (OS) was 29 months, with a 6-year OS of 41%. On an intent-to-treat analysis for patients younger than 50 years, alloBMT significantly improved the 6-year OS (75% versus 40% after ASCT; P = .0027). Randomized interferon- maintenance had no effect on relapse or survival after ASCT. In conclusion, the outcome of adult ALL is better after early alloBMT than after delayed ASCT.
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