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
While commonly accepted in poor-risk acute lymphoblastic leukemia (ALL), the role of allogeneic hematopoietic stem cell transplantation (allo-SCT) is still disputed in adult patients with standard-risk ALL. We evaluated outcome of patients with ALL in first complete remission (CR1), according to a sibling donor versus no-donor comparison. Eligible patients (433) were entered in 2 consecutive, prospective studies, of whom 288 (67%) were younger than 55 years, in CR1, and eligible to receive consolidation by either an autologous SCT or an allo-SCT. Allo-SCT was performed in 91 of 96 patients with a compatible sibling donor. Cumulative incidences of relapse at 5 years were, respectively, 24 and 55% for patients with a donor versus those without a donor (hazard ratio [HR], 0.37; 0.23-0.60; P < .001). Nonrelapse mortality estimated 16% (± 4) at 5 years after allo-SCT. As a result, disease-free survival (DFS) at 5 years was significantly better in the donor group: 60 versus 42% in the no-donor group (HR: 0.60; 0.41-0.89; P= .01). After risk-group analysis, improved outcome was more pronounced in standard-risk patients with a donor, who experienced an overall survival of 69% at 5 years (P = .05). In conclusion, standard-risk ALL patients with a sibling donor may show favorable survival following SCT, due to both a strong reduction of relapse and a modest nonrelapse mortality. This trial is registered with http://www.trialregister.nl under trial ID NTR228.
|Keywords||acute lymphoblastic leukemia, adolescent, adult, allogeneic stem cell transplantation, allotransplantation, antineoplastic agent, article, autologous stem cell transplantation, autotransplantation, cancer mortality, cancer regression, clinical trial, comparative study, controlled clinical trial, controlled study, disease free survival, female, hematopoietic stem cell transplantation, high risk population, human, immunosuppressive treatment, intermethod comparison, living donor, major clinical study, male, methodology, middle aged, organ donor, outcome assessment, priority journal, prospective study, remission, risk factor, sibling, treatment outcome, tumor recurrence|
|Persistent URL||dx.doi.org/10.1182/blood-2008-07-168625, hdl.handle.net/1765/18473|
|Note||Free full text at PubMed|
Cornelissen, J.J., van der Holt, B., Verhoef, G.E.G., van 't Veer, M.B., van Oers, M.H.J., Ossenkoppele, G.J., … Dekker, A.W.. (2009). 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, 113(6), 1375–1382. doi:10.1182/blood-2008-07-168625