Chemotherapy compared with bone marrow transplantation for adults with acute lymphoblastic leukemia in first remission

A comparison was made of the effectiveness of two approaches for treating acute lymphoblastic leukemia (ALL), a malignancy of blood cells in which bone marrow (where blood cells are made) becomes replaced by malignant tissue. The two approaches are chemotherapy and bone marrow transplantation; the latter method transplants bone marrow from a tissue-compatible donor (usually a sibling) into the patient. The study was retrospective and involved hospitals throughout the world; it evaluated the effects of treatment for 484 patients who underwent chemotherapy and 251 patients who received bone marrow transplants. All patients were treated during their first remission (period when the signs of the disease are no longer evident). The length of time after treatment that patients survived without a recurrence of leukemia was assessed. Results showed that the probability of surviving five years without leukemia was similar for both treatment groups (approximately 40 percent). Neither treatment conferred a survival advantage. While most treatment failures with chemotherapy were the result of relapse, the majority of failures with transplantation were due to complications of the procedure (graft-versus-host disease). It is likely that an effective approach to treating ALL is to administer chemotherapy first, saving transplantation for those who relapse. As many as 20 percent of relapsing patients after chemotherapy are cured by transplantation. At present, it cannot be said that bone marrow transplants offer advantages over chemotherapy for treating adult ALL in first remission. (Consumer Summary produced by Reliance Medical Information, Inc.)