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Acute Leukemias

A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor

Leukemia volume 25, pages 259–265 (2011)Cite this article

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Abstract

Clinical studies using genetic randomization cannot accurately answer whether adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) who have a human leukocyte antigen (HLA)-matched sibling should undergo allogeneic hematopoietic stem cell transplantation (HSCT) or chemotherapy in first remission, as, in these studies, patients without a sibling donor undergo alternative donor transplantation or chemotherapy alone after a relapse. Therefore, we performed a decision analysis to identify the optimal strategy in this setting. Transition probabilities and utilities were estimated from prospective studies of the Japan Adult Leukemia Study Group, the database of the Japan Society for Hematopoietic Cell Transplantation and the literature. The primary outcome measure was the 10-year survival probability with or without quality of life (QOL) adjustments. Subgroup analyses were performed according to risk stratification on the basis of white blood cell count and cytogenetics, and according to age stratification. In analyses without QOL adjustments, allogeneic HSCT in first remission was superior in the whole population (48.3 vs 32.6%) and in all subgroups. With QOL adjustments, a similar tendency was conserved (44.9 vs 31.7% in the whole population). To improve the probability of long-term survival, allogeneic HSCT in first remission is recommended for patients who have an HLA-matched sibling.

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Acknowledgements

We thank all staff of the JALSG centers and the JSHCT centers for providing excellent patient care and reporting clinical data.

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Authors and Affiliations

  1. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    S Kako & Y Kanda

  2. Department of Biostatistics and Epidemiology, Yokohama City University, Kanagawa, Japan

    S Morita

  3. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    H Sakamaki

  4. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    H Ogawa

  5. Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    T Fukuda

  6. Division of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    S Takahashi

  7. Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan

    H Kanamori

  8. Department of Hematology and Oncology, Tokai University, Kanagawa, Japan

    M Onizuka

  9. Department of Blood Transfusion, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    K Iwato

  10. Department of Hematopoietic Stem Cell Transplantation Data Management, Nagoya University School of Medicine, Aichi, Japan

    R Suzuki & Y Atsuta

  11. Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    T Kyo

  12. Department of Hematology, Saiseikai Maebashi Hospital, Gunma, Japan

    T Sakura

  13. Department of Hematology, Saitama Medical University, Saitama, Japan

    I Jinnai

  14. Division of Medicine, Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan

    J Takeuchi

  15. Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Y Miyazaki

  16. Department of Hematology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan

    S Miyawaki

  17. Oncology Center, Hamamatsu University School of Medicine, Shizuoka, Japan

    K Ohnishi

  18. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Aichi, Japan

    T Naoe

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  1. S Kako
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  2. S Morita
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  3. H Sakamaki
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  4. H Ogawa
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  5. T Fukuda
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  7. H Kanamori
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  8. M Onizuka
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  9. K Iwato
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  10. R Suzuki
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  11. Y Atsuta
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  12. T Kyo
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  13. T Sakura
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  14. I Jinnai
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  15. J Takeuchi
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  16. Y Miyazaki
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  17. S Miyawaki
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  18. K Ohnishi
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  19. T Naoe
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  20. Y Kanda
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Correspondence to Y Kanda.

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Kako, S., Morita, S., Sakamaki, H. et al. A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor. Leukemia 25, 259–265 (2011). https://doi.org/10.1038/leu.2010.260

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