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Prepublished online as a Blood First Edition Paper on May 13, 2002; DOI 10.1182/blood-2002-03-0776. This Article Full Text (PDF) All Versions of this Article: 2002-03-0776v1 100/5/1641    most recent 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 HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Powles, R. Articles by Mehta, J. Search for Related Content PubMed PubMed Citation Articles by Powles, R. Articles by Mehta, J. Social Bookmarking                   What's this? Submitted March 14, 2002 Accepted April 25, 2002 The role of post-transplant maintenance chemotherapy in improving the outcome of autotransplantation in adult acute lymphoblastic leukemia Ray Powles, Bhawna Sirohi, Jennie Treleaven, Samar Kulkarni, Diana Tait, Seema Singhal, and Jayesh Mehta* Leukaemia Unit, Royal Marsden Hospital, Sutton, Surrey, United Kingdom Leukaemia Unit, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Division of Hematology/Oncology, Northwestern University Medical School, Chicago, IL, USA * Corresponding author; email: j-mehta{at}northwestern.edu. Extending the principle of conventional acute lymphoblastic leukemia (ALL) therapy to transplantation, 77 adult patients autografted in first remission after melphalan ± total body irradiation were scheduled to receive 6-mercaptopurine (6MP), methotrexate (MTX) and vincristine-prednisone (VP) for 2 years post-transplant to reduce relapse. 71% of patients received 6MP, 57% received MTX and 38% received VP. 30 patients relapsed at 1.5-80 months (median 12.5); 15 in the first year and 7 beyond 3 years. The cumulative incidence of relapse at 10 years was 42% (95% CI: 31-55). The 10-year probabilities of disease-free (DFS) and overall (OS) survival were 50% (95% CI: 38-62) and 53% (95% CI: 41-65) respectively. Age >30 years, >4 weeks to attain remission and high-risk karyotypes [t(9;22) or t(4;11)] were adverse features contributing to the identification of 3 prognostic risk groups with 0, 1, and 2 adverse features respectively: standard (47%), intermediate (36%), and high (17%). The 10-year cumulative incidences of relapse (20%, 48%, 85%; P<0.0001) and probabilities of disease-free survival (72%, 41%, 10%; P=0.0003) were significantly different amongst these groups. In Cox analysis of the 71 patients alive and well 120 days post-transplant, those receiving 2 or 3 maintenance chemotherapy agents had significantly lower relapse and superior DFS compared with those receiving 0 or 1 agent. Our data suggest that maintenance chemotherapy improves the outcome of autografted ALL patients. However, it is unlikely that autograft-based strategies are optimal for the high-risk group of patients who should be considered for alternative-donor allograft procedures. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: M. Hunault, J.-L. Harousseau, M. Delain, M. Truchan-Graczyk, J.-Y. Cahn, F. Witz, T. Lamy, B. Pignon, J.-P. Jouet, R. Garidi, et al. Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial Blood, November 15, 2004; 104(10): 3028 - 3037. [Abstract] [Full Text] [PDF]

	Copyright © 2002 by American Society of Hematology         Online ISSN: 1528-0020