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Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial
- Source :
- Blood. 104(10)
- Publication Year :
- 2004
-
Abstract
- Various transplantation strategies have been designed to improve the poor prognosis of adult (ages 15 to 60 years) acute lymphoblastic leukemia (ALL). The GOELAL02 trial evaluated the impact of early allogeneic bone marrow transplantation (alloBMT) or delayed unpurged autologous stem cell transplantation (ASCT) for patients who had no human leukocyte antigen (HLA)-matched sibling donor or who were older than 50 years. Inclusion criteria included at least one of the following: age older than 35 years; non-T-ALL; leukocytosis greater than 30 x 10(9)/L; t(9;22), t(4;11), or t(1; 19); or failure to achieve complete remission (CR) after one induction course. Among 198 patients, the median age was 33 years. The CR rate was 80% with vincristine, idarubicine, L-asparaginase, and randomized intravenous injection or oral steroids (P = nonsignificant [ns]). AlloBMT was performed after 2 consolidation courses while ASCT was delayed after 1 additional reinduction. Intensified conditioning regimen before transplantation included etoposide, cyclophosphamide, and total body irradiation (TBI). Median follow-up was 5.1 years. The median overall survival (OS) was 29 months, with a 6-year OS of 41%. On an intent-to-treat analysis for patients younger than 50 years, alloBMT significantly improved the 6-year OS (75% versus 40% after ASCT; P = .0027). Randomized interferon-alpha maintenance had no effect on relapse or survival after ASCT. In conclusion, the outcome of adult ALL is better after early alloBMT than after delayed ASCT.
- Subjects :
- Oncology
Adult
medicine.medical_specialty
Vincristine
Cyclophosphamide
Adolescent
Immunology
Antineoplastic Agents
Biochemistry
Autologous stem-cell transplantation
Acute lymphocytic leukemia
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Asparaginase
Humans
Transplantation, Homologous
Philadelphia Chromosome
Bone Marrow Transplantation
Acute leukemia
business.industry
Daunorubicin
Remission Induction
Interferon-alpha
Cell Biology
Hematology
Total body irradiation
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
medicine.disease
Prognosis
Combined Modality Therapy
Surgery
Transplantation
Treatment Outcome
Adult Acute Lymphoblastic Leukemia
business
medicine.drug
Subjects
Details
- ISSN :
- 00064971
- Volume :
- 104
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Blood
- Accession number :
- edsair.doi.dedup.....293809d6247e0f3163ad23fa041e1720