autologous blood and marrow transplantation - Blog Science ...

60 Chapter 2: ALL
UKALL XII). This study compares, prospectively, the role of allogeneic transplant
for patients who have a matched histocompatible sibling and randomizing all other
patients to receive either conventional chemotherapy or an autologous transplant.
This study stratifies patients by risk groups but maintains study randomization for
all such groups. The only exceptions are for patients with very high-risk factors
such as the Philadelphia chromosome, detected either by standard cytogenetics or
by the presence of the bcr-abl oncogene. A search for a matched-unrelated donor
is recommended for these high-risk patients in preference to standard
chemotherapy or autologous transplantation. In this prospective randomized study,
all patients receive identical induction and intensification therapy. A direct
prospective comparison is then made between allogeneic transplantation and
autologous transplantation using identical preparative regimens and conventional
consolidation/maintenance therapy. Importantly, all treatment strategies are
decided prior to intensification therapy to allow for an intent-to-treat analysis and
an avoidance of selection biases. The study has currently accrued close to 800
patients and should be completed within the next 2 years.
Such prospective collaborative studies are critical to the understanding of the
best therapies for adult ALL in first remission and are likely to influence the
treatment strategies over the next decade.
The issue of peripheral stem cell transplants is fairly novel in ALL but is rapidly
gaining widespread experience if not unanimous acceptance. Preliminary data that
are available suggest that hematopoietic recovery is significantly improved with
this modality without evidence of increasing the risk of relapse. Assuming this can
be confirmed in subsequent data, the relatively low morbidity from such transplants
will make this procedure even more attractive as an option to significantly shorten
the traditionally long period of therapy for adult ALL.
REFERENCES
1. Chao NJ, Forman SJ, Schmidt GM, Snyder DS, Amylon MD, Konrad PN, Nademanee
AP, O'Donnell MR, Parker PM, Stein AS, et al.: Allogeneic bone marrow transplanta­
tion for high-risk acute lymphoblastic leukemia during first complete remission. Blood
78:1923-1927, 1991.
2. Kersey JH, Weisdorf D, Nesbit ME, LeBien TW, Woods WG, McGlave PB, Kim T,
Vallera DA, Goldman AI, Bostrom B, et al.: Comparison of autologous and allogeneic
bone marrow transplantation for treatment of high risk refractory acute lymphoblastic
leukemia. N Engl J Med 317:461467, 1987.
3. Uckun FM, Kersey JH, Haake R, Weisdorf D, Nesbit ME, Ramsay NK: Pretransplantation
burden of leukemic progenitor cells as a predictor of relapse after bone marrow trans­
plantation for acute lymphoblastic leukemia. N Engl J Med 329:1296-1301, 1993.
4. De Witte T, Awwad B, Boezeman J, Schattenberg A, Muus P, Raemaekers J, Preijers F,
Strijckmans P, Haanen C: Role of allogeneic bone marrow transplantation in adolescent