|
|
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.
 Previous Article | Next Article 
Submitted October 11, 2007
Accepted November 15, 2007
In adults with standard-risk acute lymphoblastic leukemia (ALL) the greatest benefit is achieved from a matched sibling allogeneic transplant in first complete remission (CR) and an autologous transplant 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 Goldstone*, Susan M. Richards, Hillard M. Lazarus, Martin S. Tallman, Georgina Buck, Adele K. Fielding, Alan K. Burnett, Raj Chopra, Peter H. Wiernik, Letizia Foroni, Elisabeth Paietta, Mark R. Litzow, David I Marks, Jill Durrant, Andrew McMillan, Ian M Franklin, Selina Luger, Niculae Ciobanu, and Jacob M. Rowe
UCL Hospitals, London, United Kingdom
Clinical Trial Service Unit, Oxford, United Kingdom
Ireland Cancer Center, University Hospitals of Cleveland, Cleveland, OH, United States
Northwestern University Feinberg School of Medicine, Chicago, IL, United States
Royal Free & University College Medical School, London, United Kingdom
University of Wales, Cardiff, United Kingdom
Universty of Wales, Cardiff, United Kingdom
Our Lady of Mercy Cancer Center, New York Medical College, New York, NY, United States
Mayo Clinic College of Medicine, Rochester, MN, United States
Bristol Haematology & Oncology Centre, Bristol, United Kingdom
Nottingham University, Nottingham, United Kingdom
University of Glasgow, National Blood Transfusion Service, Glasgow, United Kingdom
Department of Haematology/Oncology, University of Pennsylvania, Philadelphia, PA, United States
Stem Cell Sciences, Inc, New York, NY, United States
Rambam Medical Center and Technion, Israel Institute for Technology, Haifa, Israel
* Corresponding author; email: anthony.goldstone{at}uclh.nhs.uk.
An international collaboration was set up to prospectively evaluate the role of allogeneic transplantation for adults with 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 transplant.
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 = <.0001). The survival difference was significant in standard risk patients, but not in high-risk patients with a high non-relapse mortality rate in the high risk donor group. Patients randomized to chemotherapy had a higher 5-year OS, 46% than those randomized to autologous transplant, 37% (p = .03).
Matched related allogeneic transplants for ALL in first complete remission provide the most potent anti-leukemic therapy and considerable survival benefit for standard-risk patients. However, the transplant-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 transplant can replace consolidation/maintenance in any risk group. This study is registered at http://clinicaltrials.gov as NCT00002514.
 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. Oncol.,
November 1, 2009;
27(31):
5189 - 5194.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Espinoza, A. Takami, M. Onizuka, H. Sao, H. Akiyama, K. Miyamura, S. Okamoto, M. Inoue, Y. Kanda, S. Ohtake, et al.
NKG2D gene polymorphism has a significant impact on transplant outcomes after HLA-fully-matched unrelated bone marrow transplantation for standard risk hematologic malignancies
Haematologica,
October 1, 2009;
94(10):
1427 - 1434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Patel, K. E. Kirkland, R. Szydlo, R. M. Pearce, R. E. Clark, C. Craddock, E. Liakopoulou, A. K. Fielding, S. Mackinnon, E. Olavarria, et al.
Favorable outcomes with alemtuzumab-conditioned unrelated donor stem cell transplantation in adults with high-risk Philadelphia chromosome-negative acute lymphoblastic leukemia in first complete remission
Haematologica,
October 1, 2009;
94(10):
1399 - 1406.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Mansour, M. L. Sulis, V. Duke, L. Foroni, S. Jenkinson, K. Koo, C. G. Allen, R. E. Gale, G. Buck, S. 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. Baleydier, A. Simon, K. Beldjord, O. Reman, F. Witz, T. Fagot, E. Tavernier, et al.
NOTCH1/FBXW7 mutation identifies a large subgroup with favorable outcome in adult T-cell acute lymphoblastic leukemia (T-ALL): a Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL) study
Blood,
April 23, 2009;
113(17):
3918 - 3924.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Bachanova, M. R. Verneris, T. DeFor, C. G. Brunstein, and D. J. Weisdorf
Prolonged survival in adults with acute lymphoblastic leukemia after reduced-intensity conditioning with cord blood or sibling donor transplantation
Blood,
March 26, 2009;
113(13):
2902 - 2905.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Huguet, T. Leguay, E. Raffoux, X. Thomas, K. Beldjord, E. Delabesse, P. Chevallier, A. Buzyn, A. Delannoy, Y. Chalandon, et al.
Pediatric-Inspired Therapy in Adults With Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia: The GRAALL-2003 Study
J. Clin. Oncol.,
February 20, 2009;
27(6):
911 - 918.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Cornelissen, B. van der Holt, G. E. G. Verhoef, M. B. van 't Veer, M. H. J. van Oers, H. C. Schouten, G. Ossenkoppele, P. Sonneveld, J. Maertens, M. van Marwijk Kooy, et al.
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
Blood,
February 5, 2009;
113(6):
1375 - 1382.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Hoelzer and N. Gokbuget
Allogeneic Stem Cell Transplant in Acute Lymphoblastic Leukemia: Who and When?
ASCO Educational Book,
January 1, 2009;
2009(1):
355 - 359.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Huguet, N. Boissel, and H. Dombret
Acute Lymphoblastic Leukemia in Adolescents and Young Adults: Is the Treatment Paradigm Changing?
ASCO Educational Book,
January 1, 2009;
2009(1):
360 - 364.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. G. Laport, J. C. Alvarnas, J. M. Palmer, D. S. Snyder, M. L. Slovak, A. M. Cherry, R. M. 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]
|
|
|
|
|
