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Blood, 1 February 2007, Vol. 109, No. 3, pp. 944-950.
Prepublished online as a Blood First Edition Paper on October 10, 2006; DOI 10.1182/blood-2006-05-018192.
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CLINICAL TRIALS AND OBSERVATIONS
Outcome of 609 adults after relapse of acute lymphoblastic leukemia (ALL); an MRC UKALL12/ECOG 2993 study
Adele K. Fielding1,
Susan M. Richards2,
Rajesh Chopra3,
Hillard M. Lazarus4,
Mark R. Litzow5,
Georgina Buck2,
I. Jill Durrant2,
Selina M. Luger6,
David I. Marks7,
Ian M. Franklin12,
Andrew K. McMillan8,
Martin S. Tallman9,
Jacob M. Rowe10,
Anthony H. Goldstone11, Medical Research Council of the United Kingdom Adult ALL Working Party and the Eastern Cooperative Oncology Group
1 Royal Free and University College London Medical School, London, United Kingdom;
2 Clinical Trial Service Unit, Oxford, United Kingdom;
3 Christie Hospital National Health Service (NHS) Trust, Manchester, United Kingdom;
4 Case Western Reserve University, Cleveland, OH;
5 Mayo Clinic, Rochester, MN;
6 University of Pennsylvania Medical Center, Philadelphia, PA;
7 Bristol Children's Hospital, Bristol, United Kingdom;
8 Nottingham University Hospitals, Nottingham, United Kingdom;
9 Northwestern University Feinberg School of Medicine, Chicago, IL;
10 Rambam Medical Center and Technion, Haifa, Israel;
11 University College London Hospitals, London, United Kingdom;
12 University of Glasgow and Scottish National Blood Transfusion Service, Glasgow, Scotland
Most adults with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR) will relapse. We examined the outcome of 609 adults with recurring ALL, all of whom were previously treated on the Medical Research Council (MRC) UKALL12/ECOG2993 study, where the overall survival (OS) of newly diagnosed patients is 38% (95% confidence interval [CI] = 36%-41%) at 5 years. By contrast, OS at 5 years after relapse was 7% (95% CI = 4%-9%). Factors predicting a good outcome after salvage therapy were young age (OS of 12% in patients younger than 20 years vs OS of 3% in patients older than 50 years; 2P < .001) and short duration of first remission (CR1) (OS of 11% in those with a CR1 of more than 2 years versus OS of 5% in those with a CR1 of less than 2 years; 2P < .001). Treatment received in CR1 did not influence outcome after relapse. In a very highly selected subgroup of patients who were able to receive HSCT after relapse, some were long-term survivors. We conclude from a large, unselected series with mature follow-up that most adults with recurring ALL, whatever their prior treatment, cannot be rescued using currently available therapies. Prevention of recurrence is the best strategy for long-term survival in this disease.
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