autologous blood and marrow transplantation - Blog Science ...

66 Chapter 2: ALL
recent update, however, demonstrated an advantage in terms of LFS for alloBMT
compared with chemotherapy in patients 30 years old, results of chemotherapy and BMT were similar (30 vs.
26%). 16
It seems that with better management of BMT complications and a
reduction in TRM, the BMT indications in adult ALL in CR1 may be extended.
Several groups also failed to demonstrate a statistically significant advantage
for alio- or autoBMT in first CR compared with chemotherapy in prospective
trials. 6,1517
" 19
The French study group conducted a randomized trial with autoBMT
vs. chemotherapy in patients without a sibling donor and alloBMT for all patients
with sibling donors. LFS in patients treated with alloBMT (44%) was not significantly
superior to those treated with chemotherapy (32%). In high-risk patients,
however, there was a significantly better LFS for patients treated with alloBMT
(39%) compared with those in the control group (14%) treated with either
chemotherapy or autoBMT (Table 2). 20
It remains an open question whether autoBMT or chemotherapy is superior in
adult ALL patients in CR1. Generally there was a trend in favor of autoBMT
compared with chemotherapy which did not reach statistical significance. Thus,
two groups reported a higher LFS after autologous BMT compared with
chemotherapy, 54 vs. 35% 21
and 48 vs. 20-30% (depending on chemotherapy
protocol), respectively. 19
Both trials, however, included small patient numbers of
26 vs. 19 patients 21
and 19 vs. 72 patients. 19
In the large prospective, randomized
French trial, autoBMT was not superior to chemotherapy with similar TRM (4 vs.
4%), RI (57 vs. 61 %), and LFS (39 vs. 32%). 6
IDENTIFICATION OF HIGH-RISK PATIENTS
ALL is not a uniform disease but can be separated into subgroups with considerably
different LFS ranging between 50%. In addition to the
"standard" clinical risk factors (white blood cell [WBC] count, age, time to CR) 22
Table 2. Comparison of alloBMT and chemotherapy as postremission therapy in adult
ALL
DSF TRM RI
Group AlloBMT Chemo AlloBMT Chemo AlloBMT Chemo
Fiereetal. 1993 6
Zhang et al. 1995 414
Mrsic et al. 1993 19
Oh et al. 1995 16
Formanet al. 1995 18
NR, not reported; RI, relapse incidence.
44% (116) 32% (96) 16%+ 4%+ 41% 61%
34% (234) 32% (484) 53% 5% 30% 66%
52% (22) 20-30% (43) NR NR 20% 70-80%
33% (250) 27% (80) 54% 12% 28% 69%
66% (37) 55% (66) NR NR 9% 38%