Superiority of Allogeneic Hematopoietic Stem-Cell Transplantation Compared With Chemotherapy Alone in High-Risk Childhood T-Cell Acute Lymphoblastic Leukemia: Results From ALL-BFM 90 and 95.
Schrauder, Andre; Reiter, Alfred; Gadner, Helmut; Niethammer, Dietrich; Klingebiel, Thomas; Kremens, Bernhard; Peters, Christina; Ebell, Wolfram; Zimmermann, Martin; Niggli, Felix; Ludwig, Wolf-Dieter; Riehm, Hansjorg; Welte, Karl; Schrappe, Martin
Journal of Clinical Oncology.
24(36):5742-5749, December 20, 2006.
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Purpose: The role of hematopoietic stem-cell transplantation (SCT) in first complete remission (CR1) for children with very high-risk (VHR) acute lymphoblastic leukemia (ALL) is still under critical discussion.
Patients and Methods: In the ALL-Berlin-Frankfurt-Munster (BFM) 90 and ALL-BFM 95 trials, 387 patients were eligible for SCT if there was a matched sibling donor (MSD). T-cell ALL (T-ALL) patients with poor in vivo response to initial treatment represented the largest homogeneous subgroup within VHR patients.
Results: Of 191 high-risk (HR) T-ALL patients, 179 patients (94%) achieved CR1. Twenty-three patients received an MSD-SCT. Furthermore, in trial ALL-BFM 95, eight matched unrelated donors (MUDs) and five mismatched family donors (MMFDs) were used. The median time to SCT was 5 months (range, 2.4 to 10.8 months) from diagnosis. The 5-year disease-free survival (DFS) was 67% /- 8% for 36 patients who received an SCT in CR1 and 42% /- 5% for the 120 patients treated with chemotherapy alone having an event-free survival time of at least the median time to transplantation (Mantel-Byar, P = .01). Overall survival (OS) rate for the SCT group was 67% /- 8% at 5 years, whereas patients treated with chemotherapy alone had an OS rate of 47% /- 5% at 5 years (Mantel-Byar, P = .01). Outcome of patients who received MSD-SCT versus MUD-/MMFD-SCT was comparable (DFS, 65% /- 10% v 69% /- 13%, respectively). However, relapses only occurred after MSD-SCT (eight of 23 patients), whereas treatment-related mortality only occurred after MUD-/MMFD-SCT (four of 13 patients).
Conclusion: SCT in CR1 is superior to treatment with chemotherapy alone for childhood HR-T-ALL.
(C) 2006 American Society of Clinical Oncology