Risk-oriented postremission strategies in adult acute lymphoblastic leukemia: prospective confirmation of anthracycline activity in standard-risk class and role of hematopoietic stem cell transplants in high-risk groups

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

“…This is higher than the 30% to 60% 5-year DFS reported in previous multicentric studies. 3,[34][35][36][37][38][39] Our results are not related to a biased selection of good-risk patients, as the distribution of poor-risk factors in the alloBMT group was similar to that of the overall population. We believe that this good outcome of alloBMT results both from a high antileukemic effect of the intensified conditioning regimen 40 and from a low transplantation-related mortality (TRM) due to the early performance, around day 90, of alloBMT without cumulative toxicities before conditioning.…”

Treatment of Adult Acute Lymphoblastic Leukemia

“…Some trials including GMALL rely on CNS irradiation. 4,10,11,14 Risk factors for CNS disease such as elevated WBC or LDH, traumatic lumbar punctures and phenotypes as mature B-ALL and T-ALL are well known. Therefore, risk-adapted approaches to prophylaxis seem to be reasonable.…”

“…No difference is evident for OS of studies focused on SCT (N = 2696), with a weighted mean of 84% for CR and 35% for OS, [4][5][6][7] and studies with riskadapted approaches (N = 2443), with mean CR rate of 83% and OS of 36%. [10][11][12][13][14]8 Notably, only a few studies included patients aged above 60 years. 6,[9][10][11]13 Induction therapy Standard induction of adult ALL includes at least a glucocorticoid, vincristine, an anthracycline and probably asparaginase.…”

“…[10][11][12][13][14]8 Notably, only a few studies included patients aged above 60 years. 6,[9][10][11]13 Induction therapy Standard induction of adult ALL includes at least a glucocorticoid, vincristine, an anthracycline and probably asparaginase. In response to pediatric results that show a decreased central nervous system (CNS) relapse rate and improved survival, 15 prednisone is now being replaced by dexamethasone.…”

“…One is dedicated to comparative analysis of the role of stem cell transplantation (SCT) with allogeneic SCT in all patients with sibling donors 4,5,6,7 ; the other group consists of studies focused on optimization of chemotherapy with SCT only for subgroups such as Philadelphia chromosome (Ph)-positive ALL 8,9 or based on prognostic models. [10][11][12][13][14] Complete response (CR) rates ranged between 74% and 93% and the overall survival (OS) between 27% and 48%. No difference is evident for OS of studies focused on SCT (N = 2696), with a weighted mean of 84% for CR and 35% for OS, [4][5][6][7] and studies with riskadapted approaches (N = 2443), with mean CR rate of 83% and OS of 36%.…”