Originally published as JCO Early Release 10.1200/JCO.2004.10.050 on September 7 2004

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Outcome of Treatment in Adults With Acute Lymphoblastic Leukemia: Analysis of the LALA-94 Trial

From the Hôpital Edouard Herriot, Lyon; Hôpital du Haut Levêque, Pessac; Hôpital Purpan, Toulouse; Hôpital Saint-Louis; Hôpital Pitié-Salpétrière; Hôpital Necker, Paris; Institut Paoli Calmettes, Marseille; Centre Hospitalier Lapeyronie, Montpellier; Centre Hospitalier, Lille; Centre Henri Becquerel, Rouen; Hôtel-Dieu, Clermont-Ferrand; Centre Hospitalier, Caen; L’Institut National de la Santé et de la Recherche Médicale U268, Villejuif, France; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Hôpital de Jolimont, Haine St Paul, Belgium; and Westmead Hospital, Westmead, Australia

Address reprint requests to Xavier Thomas, MD, PhD, Service d’Hématologie, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France; e-mail: xavier.thomas{at}chu-lyon.fr

PURPOSE: We analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia (ALL), and re-evaluated stem-cell transplantation (SCT) for high-risk ALL.

PATIENTS AND METHODS: A total of 922 adult patients entered onto the trial according to risk groups: standard-risk ALL (group 1), high-risk ALL (group 2), Philadelphia chromosome-positive ALL (group 3), and CNS-positive ALL (group 4). All received a standard four-drug/4-week induction course. Patients from group 1 who achieved a complete remission (CR) after one course of induction therapy were randomly assigned between intensive and less intensive postremission chemotherapy, whereas those who achieved CR after salvage therapy were then included in group 2. Patients in groups 2, 3, and 4 with an HLA-identical sibling were assigned to allogeneic SCT. In groups 3 and 4, autologous SCT was offered to all other patients, whereas in group 2 they were randomly assigned between chemotherapy and autologous SCT.

RESULTS: Overall, 771 patients achieved CR (84%). Median disease-free survival (DFS) was 17.5 months, with 3-year DFS at 37%. In group 1, the 3-year DFS rate was 41%, with no difference between arms of postremission randomization. In groups 2 and 4, the 3-year DFS rates were 38% and 44%, respectively. In group 2, autologous SCT and chemotherapy resulted in comparable median DFS. Patients with an HLA-matched sibling (groups 2 and 4) had improved DFS. Three-year DFS was 24% in group 3.

CONCLUSION: Allogeneic SCT improved DFS in high-risk ALL in the first CR. Autologous SCT did not confer a significant benefit over chemotherapy for high-risk ALL.

Supported in part by PHRC No. 94-95-97.02, Ministère de l’Emploi et de la Solidarité, France.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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