Acute Leukemias - Republican Scientific Medical Library

Conventional Therapy in Adult Acute Lymphoblastic
Leukemia: Review of the LALA Program
Xavier Thomas, Denis Fiere
Contents
11.1 Introduction ................... 145
11.2 General Principles ............... 146
11.3 LALA-83 Trial (1983–1985) ........ 146
11.4 LALA-85 Trial (1985–1986) ........ 147
11.5 LALA-87 Trial (1986–1991) ........ 148
11.6 LALA-91 Pilot Study (1991–1993) ... 149
11.7 LALA-94 Trial (1994–2002) ........ 149
11.8 Results of Stem Cell Transplantation
in LALA Study Group ............ 150
11.8.1 Allogeneic Stem Cell
Transplantation ............. 150
11.8.2 Autologous Stem Cell
Transplantation ............. 151
11.9 Prognostic Factors .............. 152
11.10 Treatment of Elderly Patients ...... 152
11.11 GRAALL Trials (2003-Present) ...... 154
References ......................... 156
11.1 Introduction
The GET-LALA (Groupe d‘Etude et de Traitement de la
Leucémie Aiguë Lymphoblastique de l’Adulte) group
has performed a series of studies evaluating different aspects
of remission induction and postremission treatment
in adults with acute lymphoblastic leukemia
(ALL). The LALA group was formed by interested hematologists,
physicians, and statisticians in the beginning
of the 1980s. The first working party was set up
in 1982 with Professor Denis Fiere as chairman of the
Steering Committee, and the first randomized trial involving
multiple French centers was started in 1983.
Since then several other trials have been opened to persons
over 15 years of age. In recent years, clinical trials
have been supplemented by systematic morphologic,
immunophenotyping, cytogenetic, and molecular genetic
studies leading to the identification of different
risk groups of patients who may warrant individualized
treatments. With the development of data managing and
the establishment of a large network of collaborating
physicians and biologists, the later trials became larger,
and reporting was more reliable. The major aim of all
the trials was the improvement of remission duration
and survival rates of adult ALL patients, the definition
of prognostic factors, and the development of riskadapted
treatment strategies. The number of participating
centers in France has increased from 11 in 1982 to 47
in the LALA-94 trial that also involved 8 centers in Belgium.
Since 2002 with the creation of the GRAALL
(Group for Research on Adult Acute Lymphoblastic Leukemia),
resulting from the fusion of the LALA and GOE-
LAMS (Groupe Ouest-Est d‘étude des Leucémies et Autres
Maladies du Sang) groups, the group protocols are
administered in hospitals all over France and in some
Belgian centers. International collaborations were also
developed with the Australasian Leukemia and Lymphoma
Group (ALLG) and the Swiss Group for Clinical Cancer
Research (SAKK) allowing to randomize sufficient
numbers of patients to demonstrate the effects of treatments
in more accurately defined risk groups. Insight