Allogeneic Stem Cell Transplantation in Adult Acute Lymphoblastic Leukemia (ALL) patients <50 years old in first complete remission(CR) A Donor vs no donor comparison in the EORTC ALL-3 Study.

Reviewer: Julie Draznin Maltzman, MD
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Last Modified: December 9, 2002

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Presenter: Boris Labar
Presenter's Affiliation: EORTC
Type of Session: Reporting

Background

  • Allo transplant for ALL has been used for over 20 years but despite its' general application its role in adults remains unclear.
  • The contraversy remains between an allo transplant and an autologous transplant followed by maintenance chemotherapy for this disease in adults.

Materials and Methods

  • This is an intention to treat analysis that looked at adult ALL patients in CR after induction and consolidation therapy and randomized them to either an allo transplant (those with idenitical sib donors) and autologous transplant followed by maintenance chemotherapy.
  • 340 patients were enrolled.
  • 296 patients had large mediastinal masses
  • All patients were previously untreated for ALL
  • T and B cell ALL were included.
  • Median pt age was 33.
  • Only 279 pts were younger than 50 and 79% of those attained CR after induction and consolidation therapies.
  • 9.5 year follow up showed that 93 pts had relapsed and 26 died.

Results

  • 10 year Disease Free Survival (DFS) for allo and auto plus maintenance were similar -- 33.9% and 33.8% respectively.
  • Relapse rates were lower in the pts who underwent allo transplants than those who had auto transplants. 38% for allo vs. 59% for auto.
  • Transplant related mortality (TRM) was higher for allo patients -- 27.8% as opposed to auto 6.9%
  • 10 year overall survival for allo was 36.7% and for auto awas 34.9%. This is not statistically significant.
  • Subset analysis did not show a difference for pt age.

Author's Conclusions

  • These data by the EORTC do not prove that an allo transplant, even with an available matched donor sib, is the treatment of choice for adult ALL.
  • Although lower relapse rates were seen with allo transplants, this was offset but a much higher TRM.

Clinical/Scientific Implications

  • Allo transplantation carries a huge mortality risk and may not be the correct therapy choice for adult ALL patients despite general application.

Oncolink's ASH Coverage made possible by an unrestricted Educational Grant from Ortho Biotech.