Allogeneic stem cell transplantation in high-risk acute lymphoblastic leukaemia

A French and Australian study published in Journal of Clinical Oncology reports that allogeneic stem cell transplant is more effective than autologous transplant and standard chemotherapy in high-risk acute lymphoblastic leukaemia (ALL).This study was designed to assess the benefit of a risk-adapted strategy after remission in adult ALL. Patients were divided into four groups and treatment in the three higher risk groups could include stem cell transplant (SCT).This study built on the results of earlier Leucemie Aigues Lymphoblastique de l'Adulte Group study (LALA-87). LALA-94 was intended to assess the benefit of intensification of induction therapy, a risk-adapted post remission strategy and the value of SCT in high-risk patients.From 1994 - 2002, 1000 patients aged 15 -55 with untreated ALL were entered into the trial. In January 2004, 922 were eligible for analysis with a mean follow up of 5.2 years. All patients were randomised to receive four weeks chemotherapy with either idarubicin or daunorubicin in addition to prednisone, vincristine, and cyclophosphamide. Complete response was achieved in 771 patients (84%) with no significant differences between the two arms. Mucositis and infections were more common with idarubicin but it was associated with a longer DFS in those patients who did not go on to SCT.The prognostic groups were defined as:...