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Bone Marrow Transplantation

Autologous stem cell transplantation in adults with acute lymphoblastic leukemia in first complete remission: analysis of the LALA-85, -87 and -94 trials

Leukemia volume 20, pages 336–344 (2006)Cite this article

Abstract

To evaluate the results of autologous stem cell transplantation (ASCT) in a large population of adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR), we performed an individual data-based overview of the last three trials from the LALA group. Overall, 349 patients with ALL prospectively randomized in the consecutive LALA-85, -87, and -94 trials to receive either ASCT or chemotherapy as post-CR treatment were analyzed. Eligibility criteria were 15–50-year-old patients without sibling donors in both LALA-85/87 trials and 15–55-year-old patients with high-risk ALL and no sibling donors in the LALA-94 trial. Intent-to-treat analysis, which compared 175 patients from the ASCT arm to 174 patients from the chemotherapy arm, showed that ASCT was associated with a lower cumulative incidence of relapse (66 vs 78% at 10 years; P=0.05), without significant gain in disease-free or overall survival. Despite a possible lack of statistical power, a nested case–control analysis performed in 85 patient pairs adjusted for time to transplant and prognostic covariates confirmed these intent-to-treat results in patients actually transplanted. Of interest, the reduced relapse risk after ASCT translated in better disease-free survival in the 300 rapid responders who reached CR after the first induction course.

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Acknowledgements

We are indebted to Wim van Putten for providing Stata packages with facilities for Kaplan–Meier survival and cumulative incidence curves. This study was supported in part by Le Programme Hospitalier de Recherche Clinique (PHRC N°94-95-97.02), Ministère de l'Emploi et de la Solidarité, France; and by L'Association Contre le Cancer (National Grants ARC Nos. 6237, 9623, and 5484).

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Authors and Affiliations

  1. Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France

    N Dhédin & J-P Vernant

  2. Department of Hematology, Hôpital Saint-Louis, Paris, France

    H Dombret

  3. Department of Hematology, Hôpital Edouard Herriot, Lyon, France

    X Thomas, V Lhéritier, C Charrin & D Fière

  4. Department of Hematology, Hôpital Haut-Levêque, Pessac, France

    J-M Boiron

  5. Department of Hematology, Hôpital Purpan, Toulouse, France

    F Rigal-Huguet

  6. Department of Hematology, Institut Paoli-Calmettes, Marseille, France

    N Vey & D Blaise

  7. Department of Hematology, Hôpital Henri Mondor, Créteil, France

    M Kuentz

  8. Department of Hematology, Centre Hospitalier Universitaire, Caen, France

    O Reman

  9. Department of Hematology, Hôpital Brabois, Nancy, France

    F Witz

  10. Department of Hematology, Cliniques Universitaires St Luc, Brussels, Belgium

    A Delannoy

  11. Department of Hematology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    T Kovacsovics

  12. Department of Hematology, Westmead Hospital, Sydney, NSW, Australia

    K Bradstock

  13. INSERM U268, Hôpital Paul Brousse, Villejuif, France

    C Boucheix

  14. Department of Biochemistry and Molecular Biology, Hôpital Nord, Marseille, France

    J Gabert

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for the Groupe d'Etude et de Traitement des Leucémies Aiguës Lymphoblastiques de l'Adulte (GET-LALA), the Swiss Group for Clinical Cancer Research (SAKK), and the Australasian Leukaemia and Lymphoma Group

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Correspondence to H Dombret.

Appendix

Appendix

French participating centers were: Hôpital Pitié-Salpétrière, Paris; Hôpital Saint-Louis, Paris; Hôpital Edouard Herriot, Lyon; Hôpital du Haut Lévêque, Bordeaux; Hôpital Purpan, Toulouse; Hôpital André Mignot, Versailles; Hôpital Henri Mondor, Créteil; Hôpital Bicètre, Le Kremlin Bicètre; Institut Paoli Calmettes, Marseille; Hôpital Cochin, Paris; Hôpital de Hautepierre, Strasbourg; EFS, Besançon; Hôpital de l'Archet, Nice; Hôpital Necker, Paris; Hôpital Jean Bernard, Poitiers; Hôpital Michallon, Grenoble; Institut Gustave Roussy, Villejuif; INSERM U268, Villejuif; Hôpital du Bocage, Dijon; Hôpital Saint-Antoine, Paris; Centre Hospitalier, Caen; Hôpital Pontchaillou, Rennes; Centre Hospitalier de la Côte Basque, Bayonne; Centre Hospitalier, Lyon; HIA Percy, Clamart; HIA du Val-de-Grâce, Paris; Centre Hospitalier, Chambéry; Hôpital Dupuytren, Limoges; Centre Hospitalier, Avignon; Hôpital Louis Pasteur, Colmar; Centre Hospitalier, Mulhouse; Centre Henri Becquerel, Rouen; Centre Hospitalier, Clermont-Ferrand; Centre Hospitalier, Lille; Hôpital Beaujon, Clichy; Centre Hospitalier, Annecy; Centre Hospitalier, Perpignan; Centre Hospitalier Lapeyronie, Montpellier; Centre Hospitalier, Aix en Provence; Hôpital Jean Monod, Le Havre; Centre Hospitalier, Meaux; Hôpital Hôtel Dieu, Paris; Laboratoire CERBA, Val d'Oise; Hôpital Lariboisière, Paris; Hôpital Victor Dupouy, Argenteuil; Centre Hospitalier Dr Schaffner, Lens; Centre Hospitalier, Valenciennes; Centre Hospitalier Saint-Vincent, Lille; Centre Hospitalier, Roubaix; and ETS, Lille. Belgium participating centers were: Cliniques St Luc, Bruxelles; Centre Hospitalier Notre Dame et Reine Fabiola, Charleroi; Cliniques de Mont Godinne, Yvoir; ASBL, Loverval; Hôpital Saint-Joseph, Gilly; Hôpital de Jolimont, Haine St Paul; Hôpital Saint-Joseph, Mons; Hôpital de la Citadelle, Liège; and Laboratoire de Cytogénétique, Leuven. Swiss participating centers were: Centre Hospitalier Universitaire Vaudois, Lausanne; Kantonsspital, St Gallen; Universitätsspital, Zürich; Hôpital Cantonal Universitaire, Genève; Kantonsspital, Basel; Inselspital, Bern; Kantonsspital, Winterthur; Kantonsspital, Luzern, Switzerland. Australian participating centers were: Westmead Hospital, Westmead; Adelaide Hospital, Adelaide; Mater Misericordae Hospital, Newcastle; Alfred Hospital, Melbourne; Royal Adelaide Hospital, Adelaide; Peter Mac Callum Cancer Centre Institute, Melbourne; Monash Medical Centre, Melbourne; Liverpool Hospital, Sydney; St George Hospital, Sydney, Australia.

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Dhédin, N., Dombret, H., Thomas, X. et al. Autologous stem cell transplantation in adults with acute lymphoblastic leukemia in first complete remission: analysis of the LALA-85, -87 and -94 trials. Leukemia 20, 336–344 (2006). https://doi.org/10.1038/sj.leu.2404065

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