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Blood, 15 February 2008, Vol. 111, No. 4, pp. 1827-1833. Prepublished online as a Blood First Edition Paper on November 29, 2007; DOI 10.1182/blood-2007-10-116582. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2007-10-116582v1 111/4/1827    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 HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Goldstone, A. H. Articles by Rowe, J. M. Search for Related Content PubMed PubMed Citation Articles by Goldstone, A. H. Articles by Rowe, J. M. Related Collections Free Research Articles Clinical Trials and Observations Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS 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. Goldstone1, Susan M. Richards2, Hillard M. Lazarus3, Martin S. Tallman4, Georgina Buck2, Adele K. Fielding5, Alan K. Burnett6, Raj Chopra7, Peter H. Wiernik8, Letizia Foroni5, Elisabeth Paietta8, Mark R. Litzow9, David I. Marks10, Jill Durrant2, Andrew McMillan11, Ian M. Franklin12, Selina Luger13, Niculae Ciobanu14, and Jacob M. Rowe15 1 University College London Hospitals, London, United Kingdom; 2 Clinical Trial Service Unit, Oxford, United Kingdom; 3 Ireland Cancer Center, University Hospitals of Cleveland, Cleveland, OH; 4 Northwestern University Feinberg School of Medicine, Chicago, IL; 5 Royal Free & University College Medical School, London, United Kingdom; 6 University of Wales, Cardiff, United Kingdom; 7 Christie National Health Service Trust Hospital, Manchester, United Kingdom; 8 Our Lady of Mercy Cancer Center, New York Medical College, Bronx, NY; 9 Mayo Clinic College of Medicine, Rochester, MN; 10 Bristol Haematology & Oncology Centre, Bristol, United Kingdom; 11 Nottingham University, Nottingham, United Kingdom; 12 University of Glasgow, National Blood Transfusion Service, Glasgow, Scotland; 13 Department of Haematology/Oncology, University of Pennsylvania, Philadelphia; 14 Stem Cell Sciences, New York, NY; and 15 Rambam Medical Center and Technion, Israel Institute of Technology, Haifa An international collaboration was set up to prospectively evaluate the role of allogeneic transplantation for adults with acute lymphoblastic leukemia (ALL) and compare autologous transplantation with standard chemotherapy. Patients received 2 phases of induction and, if in remission, were assigned to allogeneic transplantation if they had a compatible sibling donor. Other patients were randomized to chemotherapy for 2.5 years versus an autologous transplantation. A donor versus no-donor analysis showed that Philadelphia chromosome–negative patients with a donor had a 5-year improved overall survival (OS), 53% versus 45% (P = .01), and the relapse rate was significantly lower (P .001). The survival difference was significant in standard-risk patients, but not in high-risk patients with a high nonrelapse mortality rate in the high-risk donor group. Patients randomized to chemotherapy had a higher 5-year OS (46%) than those randomized to autologous transplantation (37%; P = .03). Matched related allogeneic transplantations for ALL in first complete remission provide the most potent antileukemic therapy and considerable survival benefit for standard-risk patients. However, the transplantation-related mortality for high-risk older patients was unacceptably high and abrogated the reduction in relapse risk. There is no evidence that a single autologous transplantation can replace consolidation/maintenance in any risk group. This study is registered at http://clinicaltrials.gov as NCT00002514 [ClinicalTrials.gov] . CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Chemotherapy or allografting for young adults with high-risk ALL? Claudio Anasetti Blood 2008 111: 5755. [Full Text] [PDF] This article has been cited by other articles: J. B. Nachman, M. K. La, S. P. Hunger, N. A. Heerema, P. S. Gaynon, C. Hastings, L. A. Mattano Jr, H. Sather, M. Devidas, D. R. Freyer, et al. Young Adults With Acute Lymphoblastic Leukemia Have an Excellent Outcome With Chemotherapy Alone and Benefit From Intensive Postinduction Treatment: A Report From the Children's Oncology Group J. Clin. 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Richards, et al. Prognostic Implications of NOTCH1 and FBXW7 Mutations in Adults With T-Cell Acute Lymphoblastic Leukemia Treated on the MRC UKALLXII/ECOG E2993 Protocol J. Clin. Oncol., September 10, 2009; 27(26): 4352 - 4356. [Abstract] [Full Text] [PDF] M. B. Tomblyn, M. Arora, K. S. Baker, B. R. Blazar, C. G. Brunstein, L. J. Burns, T. E. DeFor, K. E. Dusenbery, D. S. Kaufman, J. H. Kersey, et al. Myeloablative Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia: Analysis of Graft Sources and Long-Term Outcome J. Clin. Oncol., August 1, 2009; 27(22): 3634 - 3641. [Abstract] [Full Text] [PDF] A. K. Fielding, J. M. Rowe, S. M. Richards, G. Buck, A. V. Moorman, I. J. Durrant, D. I. Marks, A. K. McMillan, M. R. Litzow, H. M. Lazarus, et al. 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 Blood, May 7, 2009; 113(19): 4489 - 4496. [Abstract] [Full Text] [PDF] M. Stark, C. Wichman, I. Avivi, and Y. G. Assaraf Aberrant splicing of folylpolyglutamate synthetase as a novel mechanism of antifolate resistance in leukemia Blood, April 30, 2009; 113(18): 4362 - 4369. [Abstract] [Full Text] [PDF] R. Bassan, O. Spinelli, E. Oldani, T. Intermesoli, M. Tosi, B. Peruta, G. Rossi, E. Borlenghi, E. M. Pogliani, E. Terruzzi, et al. Improved risk classification for risk-specific therapy based on the molecular study of minimal residual disease (MRD) in adult acute lymphoblastic leukemia (ALL) Blood, April 30, 2009; 113(18): 4153 - 4162. [Abstract] [Full Text] [PDF] V. Asnafi, A. Buzyn, S. Le Noir, F. 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Wong, R. S. Negrin, K. G. Blume, and S. J. Forman Long-term remission of Philadelphia chromosome-positive acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation from matched sibling donors: a 20-year experience with the fractionated total body irradiation-etoposide regimen Blood, August 1, 2008; 112(3): 903 - 909. [Abstract] [Full Text] [PDF] J. M. Rowe Allografting in ALL: the net widens Blood, July 15, 2008; 112(2): 212 - 212. [Full Text] [PDF] J. Mehta Hematopoietic stem cell transplantation from unrelated donors for acute leukemia Blood, July 15, 2008; 112(2): 447 - 448. [Full Text] [PDF] D. I. Marks, D. J. Weisdorf, and M.-J. Zhang Response: Unrelated donor transplantation for adults with Ph- ALL in first complete remission Blood, July 15, 2008; 112(2): 448 - 449. [Full Text] [PDF] D. I. Marks, W. S. Perez, W. He, M.-J. Zhang, M. R. Bishop, B. J. Bolwell, C. N. Bredeson, E. A. Copelan, R. P. Gale, V. Gupta, et al. Unrelated donor transplants in adults with Philadelphia-negative acute lymphoblastic leukemia in first complete remission Blood, July 15, 2008; 112(2): 426 - 434. [Abstract] [Full Text] [PDF] C. Anasetti Chemotherapy or allografting for young adults with high-risk ALL? Blood, June 15, 2008; 111(12): 5755 - 5755. [Full Text] [PDF] N. S. Majhail Old and New Cancers after Hematopoietic-Cell Transplantation Hematology, January 1, 2008; 2008(1): 142 - 149. [Abstract] [Full Text] [PDF] A. Fielding The Treatment of Adults with Acute Lymphoblastic Leukemia Hematology, January 1, 2008; 2008(1): 381 - 389. [Abstract] [Full Text] [PDF]

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