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Allografting

Event-free survival and cost-effectiveness in adult acute lymphoblastic leukaemia in first remission treated with allogeneic transplantation

Bone Marrow Transplantation volume 40, pages 643–649 (2007)Cite this article

Abstract

Allogeneic transplantation in patients with acute lymphoblastic leukaemia in first remission (ALL-CR1) has been studied in several clinical trials. However, no pooled survival analysis has yet been done. We conducted a survival meta-analysis to compare allogeneic transplantation vs chemotherapy or autologous transplantation using an intention-to-treat approach. Our study included the controlled clinical trials, wherein allocation to allogeneic transplant was based on donor availability. The event-free individual survival data were reconstructed on the basis of published information and Kaplan–Meier graphs. We then generated the meta-analytic event-free survival curves for the two treatments. The mean survival gain per patient was estimated and a simplified cost-effectiveness assessment was carried out. In the allogeneic transplantation group, 293 patients were examined and 479 as controls (four trials). The event-free survival difference was statistically significant (P=0.011). The relative risk for event occurrence was 0.79 for the experimental group vs the controls (95% CI: 0.66–0.96; P=0.017). The mean survival gain was 1 year per patient. The cost per life-year gained was less than the conventional threshold of €50 000. Allogeneic transplantation in ALL-CR1 improves event-free survival as compared to chemotherapy or autologous transplantation. Its cost-effectiveness profile is acceptable.

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Authors and Affiliations

  1. Laboratory of Pharmacoeconomis, Pharmaceutical Service, Azienda Ospedaliera Universitaria, Careggi, Firenze, Italy

    C Orsi & A Messori

  2. Hematology Unit, University of Firenze, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy

    B Bartolozzi & A Bosi

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  1. C Orsi
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  2. B Bartolozzi
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Correspondence to C Orsi.

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Orsi, C., Bartolozzi, B., Messori, A. et al. Event-free survival and cost-effectiveness in adult acute lymphoblastic leukaemia in first remission treated with allogeneic transplantation. Bone Marrow Transplant 40, 643–649 (2007). https://doi.org/10.1038/sj.bmt.1705790

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