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Allogeneic Transplantation Does not Result in Improved Survival Compared in Adults With Acute Lymphoblastic Leukemia: Presented at ASBMT

By Alan McClelland

HONOLULU, HI -- February 21, 2006 -- A comparison of disease-free survival (DFS) and survival rates in adults with acute lymphoblastic leukemia (ALL) who received allogeneic stem cell transplantation versus those receiving autologous stem cell transplantation or maintenance therapy revealed that allo-SCT does not result in a significantly better outcome.

In a presentation here on February 16^th at the 2006 Blood and Marrow Transplantation Tandem Meetings (ASBMT), Boris Labar, MD, Hematologist, Department of Internal Medicine, University Hospital Center Rebro, Zagreb, Croatia, presented the results of an intention to treat analysis that compared the three treatment methods.

The European Organization for Research and Treatment of Cancer (EORTC) ALL-4 phase 3 trial, conducted between 1998 and 2003, enrolled 325 patients ranging in age from 15 to 72 years. The median follow up time was 4.9 years.

The researchers performed human leukocyte antigen (HLA) typing on 227 patients out of a total of 248 who reached complete remission (CR). They found that 100 subjects had an identical sibling donor and 127 patients had no sibling donor. Of the 127 patients with no sibling donor, 69 received allogeneic stem cell transplantation and 58 received either autologous transplantation or high maintenance therapy.

The difference in 5-year DFS rate between the allografted patients and those who received an autologous graft or maintenance therapy was not statistically significant (41.8% vs. 35.5%). However, the rate of relapse was significantly lower in the allograft group versus the group lacking a donor ((37.3% vs. 58.8%).

The rate of treatment related mortality in the allogeneic stem cell transplantation group was substantially higher (20.9%) compared with the group lacking a donor (5.7%), and fungal infections were a major cause of death.

The authors concluded that the high treatment related mortality associated with allotransplantation remains the main problem contributing to the lack of a better outcome compared with other treatment options. Suggested approaches to reduce mortality include modifications to the therapeutic regimen before transplantation and the timing of the allograft transplantation, they said.


[Presentation title: Allogeneic Transplantation for Adult Acute Lymphoblastic Leukemia: Intention to Treat Analysis of the EORTC ALL-4 Phase III Trial. Abstract 12]

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