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Blood, 1 February 2007, Vol. 109, No. 3, pp. 944-950.
Prepublished online as a Blood First Edition Paper on October 10, 2006; DOI 10.1182/blood-2006-05-018192.
 Previous Article | Next Article 
Submitted May 5, 2006
Accepted August 7, 2006
Outcome of 609 adults after relapse of acute lymphoblastic leukaemia (ALL); an MRC UKALL12/ECOG 2993 study
Adele K. Fielding*, Susan M Richards, Rajesh Chopra, Hillard M Lazarus, Mark Litzow, Georgina Buck, I Jill Durrant, Selina M Luger, David I Marks, Andrew K McMillan, Martin S Tallman, Jacob M Rowe, and Anthony H Goldstone
Royal Free and University College London Medical School, London, UK
Clinical Trials Service Unit, Oxford, UK
Christie Hospital NHS Trust, Manchester, UK
Case Western Reserve University, Cleveland, OH, USA
Mayo Clinic, Rochester, MN, USA
Clinical Trials Servcie Unit, Oxford, UK
University of Pennsylvania Medical Center, Philadelphia, PA, USA
Bristol Childrens Hospital, Bristol, UK
Nottingham University Hospitals, Nottingham, UK
Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Rambam Medical Center and Technion, Haifa, Israel
University College London Hospitals, London, UK
* Corresponding author; email: a.fielding{at}medsch.ucl.ac.uk.
The majority of adults with ALL who achieve complete remission (CR) will relapse. We examined the outcome of 609 adults with relapsed ALL, all of whom were previously treated on the MRC UKALL12/ECOG2993 study, where the overall survival (OS) of newly diagnosed patients is 38% (95% confidence interval (CI) = 36-41%) at 5 years. By contrast, OS at 5 years after relapse was 7% (95% CI = 4-9%). Factors predicting a good outcome after salvage therapy were age (OS 12% in patients <20 years versus OS 3% in patients >50 years, 2P <0.00005) and duration of first remission (CR1) (OS 11% in those with CR1 >2 years versus OS 5% in those with CR1 <2 years, 2P <0.00005). Treatment received in CR1 did not influence outcome after relapse. In a very highly selected sub-group of patients who were able to receive HSCT after relapse, some were long-term survivors. We conclude from a large, unselected series with mature follow-up that most adults with relapsed ALL, whatever their prior treatment, cannot be rescued using currently available therapies. Prevention of relapse is the best strategy for long-term survival in this disease.
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