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Blood, 15 June 2008, Vol. 111, No. 12, pp. 5755. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Anasetti, C. Search for Related Content PubMed PubMed Citation Articles by Anasetti, C. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CORRESPONDENCE Chemotherapy or allografting for young adults with high-risk ALL? To the editor: The recent paper by Goldstone et al1 reported the results of a prospective clinical trial testing the role of allogeneic hematopoietic cell transplantation compared with chemotherapy in the treatment of acute lymphoblastic leukemia (ALL) in adults. Using an unbiased donor/no donor analysis, the study showed that allogeneic transplantation is beneficial in preventing relapse and improving the 5-year survival in Ph-negative ALL patients up to the age of 55. This study is likely to change current practice and introduce the use of allografting for adults with ALL in first remission. The issues started to arise when subsets of patients were analyzed, and the authors concluded that high-risk patients did not significantly benefit from having a donor. The wrinkle in this paper lies in the definition of risk that included age greater than 35 years and high blast counts at diagnosis. Older age is a risk factor for leukemia relapse, but it is also an important risk factor for nonrelapse mortality after transplantation. High blast count at diagnosis is a risk factor for leukemia relapse. It is, therefore, important to assess whether patients younger than 35 years at transplantation but with high blast counts at diagnosis would do better with allografting than chemotherapy. The analysis should be presented as published in Rowe et al,2 where patients are classified into 4 risk groups: younger than 35 years and low blast counts, younger than 35 years and high blast counts, older than 35 years and low blast counts, and older than 35 years and high blast counts. Authorship Conflict-of-interest disclosure: The author declares no competing financial interests. Correspondence: Claudio Anasetti, Moffitt Cancer Center, 12902 Magnolia Drive, WCB-BMT, Tampa, FL 33612-9497; e-mail: claudio.anasetti{at}moffitt.org. Claudio Anasetti References Goldstone AH, Richards SM, Lazarus HM, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood. 2008;111:1827–1833.[Abstract/Free Full Text] Rowe JM, Buck G, Burnett AK, et al. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005;106:3760–3767.[Abstract/Free Full Text] CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: Response: Chemotherapy or allografting for young adults with high-risk ALL? Anthony H. Goldstone, Susan M. Richards, Adele K. Fielding, and Jacob M. Rowe Blood 2008 111: 5755. [Full Text] [PDF] In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: final results of the International ALL Trial (MRC UKALL XII/ECOG E2993) Anthony H. Goldstone, Susan M. Richards, Hillard M. Lazarus, Martin S. Tallman, Georgina Buck, Adele K. Fielding, Alan K. Burnett, Raj Chopra, Peter H. Wiernik, Letizia Foroni, Elisabeth Paietta, Mark R. Litzow, David I. Marks, Jill Durrant, Andrew McMillan, Ian M. Franklin, Selina Luger, Niculae Ciobanu, and Jacob M. Rowe Blood 2008 111: 1827-1833. 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