Autologous stem cell transplantation in adults with acute lymphoblastic leukemia in first complete remission: analysis of the LALA-85, -87 and -94 trials

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 ¼ 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.

Long-term outcomes of adults with acute lymphoblastic leukemia after autologous or unrelated donor bone marrow transplantation: a comparative analysis by the National Marrow Donor Program and Center for International Blood and Marrow Transplant Research

“…However, when the results are examined, focusing on treatment-related mortality and relapse, they are similar to those of recent reports with much shorter follow-up. 8,25,26 The significant advantage of this data set is that it provides long-term follow-up, out to 7 years, for both autologous and URD HSCT, and may aid both physicians and patients in their clinical decision-making.…”

Autologous hematopoietic cell transplantation for high-risk ALL

“…1 Several phase III studies have failed to demonstrate the superiority of AHCT over conventional chemotherapy. [2][3][4][5] We hypothesized that an intensified approach might improve the outcomes of AHCT for adults with ALL. We used an intensive consolidation treatment with high-dose cytarabine and etoposide that has been used in AHCT for AML and has produced excellent hematopoietic cell mobilization.…”

Autologous hematopoietic stem cell transplantation in adult acute lymphoblastic leukemia: still not out of fashion

“…Even in the International ALL Trial (MRC UKALL XII/ECOG E2993), the administration of a single autoHSCT instead of consolidation treatment resulted in decreased leukemia-free survival (LFS) [10]. On the other hand, the French group revealed that autoHSCT was associated with a lower relapse rate and improved LFS compared to the chemotherapy consolidation [12]. The retrospective analysis of the European Working Group for ALL showed surprisingly good results for autoHSCT among adult ALL patients, if prior to transplantation, the level of minimal residual disease (MRD) is below 0.1% [13].…”