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Blood, 7 May 2009, Vol. 113, No. 19, pp. 4489-4496.
Prepublished online as a Blood First Edition Paper on February 24, 2009; DOI 10.1182/blood-2009-01-199380.
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Submitted January 15, 2009
Accepted February 9, 2009
Prospective outcome data on 267 unselected adult patients with Philadelphia-chromosome positive acute lymphoblastic leukaemia confirms superiority of allogeneic transplant over chemotherapy in the pre-imatinib era: Results from the international ALL trial MRC UKALLXII/ECOG2993
Adele K. Fielding*, Jacob M. Rowe, Susan M. Richards, Georgina Buck, Anthony V. Moorman, I. Jill Durrant, David I. Marks, Andrew K. McMillan, Mark R. Litzow, Hillard M. Lazarus, Letizia Foroni, Gordon Dewald, Ian M. Franklin, Selina M. Luger, Elisabeth Paietta, Peter H. Wiernik, Martin S. Tallman, and Anthony H. Goldstone
University College London, London, United Kingdom
Rambam Medical Center and Technicon, Israel Institute of Technology, Haifa, Israel
Clinical Trial Service Unit, Oxford, United Kingdom
Northern Institute for Cancer Research, Newcastle University, Newcastle, United Kingdom
Bristol Haematology & Oncology Centre, Bristol, United Kingdom
Nottingham University, Nottingham, United Kingdom
Mayo Clinic College of Medicine, Rochester, MN, United States
Ireland Cancer Center, University Hospitals of Cleveland, Cleveland, OH, United States
Imperial College London, London, United Kingdom
University of Glasgow, National Blood Transfusion Service, Glasgow, Scotland, United Kingdom
University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA, United States
Montefiore Medical Center North Division and New York Medical College, Bronx, NY, United States
Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
University College London Hospitals, London, United Kingdom
* Corresponding author; email: a.fielding{at}medsch.ucl.ac.uk.
Prospective data on the value of allogeneic haematopoietic stem cell transplant (alloHSCT) in Philadelphia chromosome positive (Ph pos) acute lymphoblastic leukaemia (ALL) are limited. The UKALLXII/ECOG 2993 study evaluated the outcome of assigning alloHSCT - with a sibling (sib) or matched unrelated donor (MUD) - to patients below the age of 55 achieving complete remission (CR). The CR rate of 267 patients, median age 40, was 82%. Twenty-eight percent of patients proceeded to alloHSCT in CR1. Age > 55 or a pre-HSCT event were the most common reasons for failure to progress to alloHSCT. At 5 years, OS was 44% following sib alloHSCT, 36% following MUD alloHSCT, and 19% following chemotherapy. After adjustment for sex, age and WBC and excluding chemotherapy-treated patients who relapsed or died before the median time to alloHSCT, only RFS remained significantly superior in the alloHSCT group (OR 0.31, CI 0.16-0.61). An intention-to-treat analysis, using the availability or not of a matched sibling donor, showed 5-year OS to be non-significantly better at 34% with a donor versus 25% with no donor. This prospective trial in adult Ph pos ALL indicates a modest but significant benefit to alloHSCT. This trial has been registered with clinicaltrials.gov under indentifier NCT00002514 and as ISRCTN77346223.
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