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Blood, 15 November 2004, Vol. 104, No. 10, pp. 3028-3037.
Prepublished online as a Blood First Edition Paper on July 15, 2004; DOI 10.1182/blood-2003-10-3560.
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Submitted November 7, 2003
Accepted April 25, 2004
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
Mathilde Hunault, Jean-Luc Harousseau, Martine Delain, Malgorzata Truchan-Graczyk, Jean-Yves Cahn, Francis Witz, Thierry Lamy, Bernard Pignon, Jean-Pierre Jouet, Reda Garidi, Denis Caillot, Christian Berthou, Denis Guyotat, Alain Sadoun, Jean-Jacques Sotto, Bruno Lioure, Philippe Casassus, Philippe Solal-Celigny, Laure Stalnikiewicz, Bruno Audhuy, Odile Blanchet, Laurence Baranger, Marie-Christine Bene, and Norbert Ifrah*
Hematology, CHU, Angers, France
Hematology, CHU, Nantes, France
Hematology, CHU, Tours, France
Hematology, CHU, Besancon, France
Hematology, CHU, Nancy, France
Hematology, CHU, Rennes, France
Hematology, CHU, Reims, France
Hematology, CHU, Lille, France
Hematology, CHU, Amiens, France
Hematology, CHU, Dijon, France
Hematology, CHU, Brest, France
Hematology, CHU, Saint Etienne, France
Hematology, CHU, Poitiers, France
Hematology, CHU, Grenoble, France
Hematology, CHU, Strasbourg, France
Hematology, CHU, Bobigny, France
Hematology, CHU, Le Mans, France
Hematology, CHR, Lens, France
Hematology, CHR, Colmar, France
Molecular Biology Department, CHU, Angers, France
Cytogenetic Department, CHU, Angers, France
Immunology Department, CHU, Nancy, France
* Corresponding author; email: noifrah{at}chu-angers.fr.
Various transplant strategies have been designed to improve the poor prognosis of adult (15-60) acute lymphoblastic leukemia (ALL). The GOELAL02 trial evaluated the impact of early allogeneic bone-marrow transplantation (alloBMT) or delayed unpurged autologous stem-cell transplantation (ASCT) for patients without HLA-matched sibling donor or over 50 years. Inclusion criteria included at least one of the following: age > 35 years, non-T ALL, leukocytosis > 30 x 109/L, t(9;22), t(4;11) or t(1;19); failure to achieve complete remission (CR) after one induction course. Among 198 patients the median age was 33 years. The CR rate was 80% with vincristine, idarubicine, L-asparaginase and randomized IV or oral steroids (P=ns). AlloBMT was performed after two consolidation courses while ASCT was delayed after one additional reinduction. Intensified conditioning regimen before transplant included etoposide, cyclophosphamide and TBI. Median follow-up was 5.1 years. The median overall survival (OS) was 29 months with a 6-year OS of 41%. On an intent-to-treat analysis for patients < 50, alloBMT improved significantly the 6-year OS (75% versus 40% after ASCT; P = .0027). Randomized Interferon- alpha maintenance had no effect on relapse or survival after ASCT. In conclusion, the outcome of adult ALL is better after early alloBMT than after delayed ASCT.
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