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 Blood, 5 February 2009, Vol. 113, No. 6, pp. 1375-1382.
Prepublished online as a Blood First Edition Paper on November 14, 2008; DOI 10.1182/blood-2008-07-168625.

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TRANSPLANTATION

Myeloablative allogeneic versus autologous stem cell transplantation in adult patients with acute lymphoblastic leukemia in first remission: a prospective sibling donor versus no-donor comparison

Jan J. Cornelissen1,15, Bronno van der Holt1,15, Gregor E. G. Verhoef2,15, Mars B. van 't Veer1,15, Marinus H. J. van Oers3,15, Harry C. Schouten4,15, Gert Ossenkoppele5,15, Pieter Sonneveld1,15, Johan Maertens2,15, Marinus van Marwijk Kooy6,15, Martijn R. Schaafsma7,15, Pierre W. Wijermans8,15, Douwe H. Biesma9,15, Shulamit Wittebol10,15, Paul J. Voogt11,15, Joke W. Baars12,15, Pierre Zachée13,15, Leo F. Verdonck14,15, Bob Löwenberg1,15, Adriaan W. Dekker14,15, on behalf of the Dutch-Belgian HOVON Cooperative Group

1 Erasmus University Medical Center, Rotterdam, The Netherlands; 2 University Hospital Gasthuisberg, Leuven, Belgium; 3 Amsterdam Medical Center, Amsterdam, The Netherlands; 4 University Hospital, Maastricht, The Netherlands; 5 Vrije Universiteit (VU) Medical Center, Amsterdam, The Netherlands; 6 Isala Clinics-Sophia, Zwolle, The Netherlands; 7 Medisch Spectrum Twente, Enschede, The Netherlands; 8 Haga Hospital, Den Haag, The Netherlands; 9 Sint Antonius Hospital, Nieuwegein, The Netherlands; 10 Meander Medical Center, Amersfoort, The Netherlands; 11 Atrium Medical Center, Heerlen, The Netherlands; 12 Netherlands Cancer Institute, Amsterdam, The Netherlands; 13 Ziekenhuis Netwerk Antwerpen (ZNA) Stuivenberg, Antwerp, Belgium; 14 University Medical Center, Utrecht, The Netherlands; and 15 Dutch-Belgian Cooperative Trial Group for Hematology Oncology (HOVON)

While commonly accepted in poor-risk acute lymphoblastic leukemia (ALL), the role of allogeneic hematopoietic stem cell transplantation (allo-SCT) is still disputed in adult patients with standard-risk ALL. We evaluated outcome of patients with ALL in first complete remission (CR1), according to a sibling donor versus no-donor comparison. Eligible patients (433) were entered in 2 consecutive, prospective studies, of whom 288 (67%) were younger than 55 years, in CR1, and eligible to receive consolidation by either an autologous SCT or an allo-SCT. Allo-SCT was performed in 91 of 96 patients with a compatible sibling donor. Cumulative incidences of relapse at 5 years were, respectively, 24 and 55% for patients with a donor versus those without a donor (hazard ratio [HR], 0.37; 0.23-0.60; P < .001). Nonrelapse mortality estimated 16% (± 4) at 5 years after allo-SCT. As a result, disease-free survival (DFS) at 5 years was significantly better in the donor group: 60 versus 42% in the no-donor group (HR: 0.60; 0.41-0.89; P = .01). After risk-group analysis, improved outcome was more pronounced in standard-risk patients with a donor, who experienced an overall survival of 69% at 5 years (P = .05). In conclusion, standard-risk ALL patients with a sibling donor may show favorable survival following SCT, due to both a strong reduction of relapse and a modest nonrelapse mortality. This trial is registered with http://www.trialregister.nl under trial ID NTR228.


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