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Blood, 1 December 2005, Vol. 106, No. 12, pp. 3760-3767.
Prepublished online as a Blood First Edition Paper on August 16, 2005; DOI 10.1182/blood-2005-04-1623.
 Previous Article | Table of Contents | Next Article 
CLINICAL TRIALS AND OBSERVATIONS
Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993
Jacob M. Rowe,
Georgina Buck,
Alan K. Burnett,
Raj Chopra,
Peter H. Wiernik,
Susan M. Richards,
Hillard M. Lazarus,
Ian M. Franklin,
Mark R. Litzow,
Niculae Ciobanu,
H. Grant Prentice,
Jill Durrant,
Martin S. Tallman,
Anthony H. Goldstone, for ECOG and the MRC/NCRI Adult Leukemia Working Party
From the Rambam Medical Center and Technion, Israel Institute of Technology, Haifa, Israel; Cancer Trials Support Unit (CTSU), Oxford, United Kingdom; University of Wales, Cardiff, United Kingdom; Christie Hospital National Health Service (NHS) Trust, Manchester, United Kingdom; Our Lady of Mercy Cancer Center, New York Medical College, Bronx, NY; Ireland Cancer Center, University Hospitals of Cleveland, OH; Glasgow Royal Infirmary, Glasgow, United Kingdom; Mayo Clinic College of Medicine, Rochester, MN; Stem Cell Sciences, New York, NY; Royal Free Hospital, London, United Kingdom; Northwestern University Feinberg School of Medicine, Chicago, IL; and University College London (UCL) Hospitals, London, United Kingdom.
The international acute lymphoblastic leukemia (ALL) study was designed to prospectively define the optimal therapy for adults 60 years of age or younger with newly diagnosed ALL. All patients received identical induction therapy, and 91% achieved complete remission (CR). Patients 50 years of age or younger with a compatible sibling were assigned to undergo allogeneic transplantation; the others were randomly assigned to autologous transplantation or to consolidation/maintenance therapy for 2.5 years. Patients who did not achieve CR after induction had an overall survival rate of 5% compared with 45% for patients who achieved CR. Factors at diagnosis predictive of overall survival and disease-free survival were age (P = .001), white blood cell count less than 30 x 109/L for B lineage or less than 100 x 109/L for T lineage (P = .001) and immunophenotype, T lineage versus B lineage (P = .001). The data demonstrate that achieving CR with induction therapy is indispensable for long-term survival in adult patients with ALL. Furthermore, with a response rate greater than 90%, the induction regimen was highly efficacious as remission-inducing therapy. This large database has validated several previously identified independent prognostic factors in ALL, such as age, white blood cell count at presentation, cytogenetics, and immunophenotype. However, the achievement of CR within 4 weeks does not appear to be an independent prognostic factor.
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