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Blood, 7 May 2009, Vol. 113, No. 19, pp. 4489-4496. Prepublished online as a Blood First Edition Paper on February 24, 2009; DOI 10.1182/blood-2009-01-199380. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2009-01-199380v1 113/19/4489    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Fielding, A. K. Articles by Goldstone, A. H. Search for Related Content PubMed PubMed Citation Articles by Fielding, A. K. Articles by Goldstone, A. H. Related Collections Free Research Articles Lymphoid Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Prospective outcome data on 267 unselected adult patients with Philadelphia chromosome–positive acute lymphoblastic leukemia confirms superiority of allogeneic transplantation over chemotherapy in the pre-imatinib era: results from the International ALL Trial MRC UKALLXII/ECOG2993 Adele K. Fielding1, Jacob M. Rowe2, Susan M. Richards3, Georgina Buck3, Anthony V. Moorman4, I. Jill Durrant3, David I. Marks5, Andrew K. McMillan6, Mark R. Litzow7, Hillard M. Lazarus8, Letizia Foroni9, Gordon Dewald7, Ian M. Franklin10, Selina M. Luger11, Elisabeth Paietta12, Peter H. Wiernik12, Martin S. Tallman13, and Anthony H. Goldstone14 1 University College London, London, United Kingdom; 2 Rambam Medical Center and Technicon, Israel Institute of Technology, Haifa, Israel; 3 Clinical Trial Service Unit, Oxford, United Kingdom; 4 Northern Institute for Cancer Research, Newcastle University, Newcastle, United Kingdom; 5 Bristol Haematology and Oncology Centre, Bristol, United Kingdom; 6 Nottingham University, Nottingham, United Kingdom; 7 Mayo Clinic College of Medicine, Rochester, MN; 8 Ireland Cancer Center, University Hospitals of Cleveland, OH; 9 Imperial College London, London, United Kingdom; 10 University of Glasgow, National Blood Transfusion Service, Glasgow, United Kingdom; 11 Abramson Cancer Center, University of Pennsylvania, Philadelphia; 12 Montefiore Medical Center North Division and New York Medical College, Bronx; 13 Northwestern University Feinberg School of Medicine, Chicago, IL; and 14 University College London Hospitals, London, United Kingdom Prospective data on the value of allogeneic hematopoietic stem cell transplantation (alloHSCT) in Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (ALL) are limited. The UKALLXII/ECOG 2993 study evaluated the outcome of assigning alloHSCT with a sibling (sib) or matched unrelated donor (MUD) to patients younger than 55 years of age achieving complete remission (CR). The CR rate of 267 patients, median age 40, was 82%. Twenty-eight percent of patients proceeded to alloHSCT in first CR. Age older than 55 years or a pre-HSCT event were the most common reasons for failure to progress to alloHSCT. At 5 years, overall survival (OS) was 44% after sib alloHSCT, 36% after MUD alloHSCT, and 19% after chemotherapy. After adjustment for sex, age, and white blood count and excluding chemotherapy-treated patients who relapsed or died before the median time to alloHSCT, only relapse-free survival remained significantly superior in the alloHSCT group (odds ratio 0.31, 95% confidence interval 0.16-0.61). An intention-to-treat analysis, using the availability or not of a matched sibling donor, showed 5-year OS to be nonsignificantly better at 34% with a donor versus 25% with no donor. This prospective trial in adult Ph+ ALL indicates a modest but significant benefit to alloHSCT. This trial has been registered with clinicaltrials.gov under identifier NCT00002514 [ClinicalTrials.gov] and as ISRCTN77346223 [controlled-trials.com] . CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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