Autologous stem cell transplantation in adults with acute lymphoblastic leukemia in first complete remission: analysis of the LALA-85,-87 and-94 trials
(2006) Leukemia — Vol. 20, n° 2, p. 336-344 (2006)
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- Abstract
- To evaluate the results of autologous stem cell transplantation ( ASCT) in a large population of adults with acute lymphoblastic leukemia ( ALL) in first complete remission (CR), we performed an individual data-based overview of the last three trials from the LALA group. Overall, 349 patients with ALL prospectively randomized in the consecutive LALA-85, -87, and -94 trials to receive either ASCT or chemotherapy as post-CR treatment were analyzed. Eligibility criteria were 15-50-year-old patients without sibling donors in both LALA-85/87 trials and 15-55-year- old patients with high-risk ALL and no sibling donors in the LALA-94 trial. Intent-to-treat analysis, which compared 175 patients from the ASCT arm to 174 patients from the chemotherapy arm, showed that ASCT was associated with a lower cumulative incidence of relapse ( 66 vs 78% at 10 years; P=0.05), without significant gain in disease-free or overall survival. Despite a possible lack of statistical power, a nested case-control analysis performed in 85 patient pairs adjusted for time to transplant and prognostic covariates confirmed these intent-to-treat results in patients actually transplanted. Of interest, the reduced relapse risk after ASCT translated in better disease-free survival in the 300 rapid responders who reached CR after the first induction course.
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Dhedin, N., Dombret, H., Thomas, X., Lheritier, V., Boiron, J., Rigal-Huguet, F., Vey, N., Kuentz, M., Reman, O., Witz, F., Delannoy, A., Kovacsovics, T., Bradstock, K., Charrin, C., Boucheix, C., Gabert, J., Blaise, D., Fiere, D., & Vernant, JP. (2006). Autologous stem cell transplantation in adults with acute lymphoblastic leukemia in first complete remission: analysis of the LALA-85,-87 and-94 trials. Leukemia, 20(2), 336-344. https://doi.org/10.1038/sj.leu.2404065 (Original work published 2006)