Chemotherapy vs HLA-identical sibling bone marrow transplants for adults with acute lymphoblastic leukemia in first remission

H. Oh, R. P. Gale, M. J. Zhang, J. R. Passweg, T. Ino, H. Murakami, R. Ohno, P. A. Rowlings, K. A. Sobocinski, M. Tanimoto, M. Tomonaga, D. J. Weisdorf, M. M. Horowitz

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Abstract

There is controversy about whether chemotherapy or an HLA-identical sibling bone marrow transplant is better treatment for adults with acute lymphoblastic leukemia (ALL) in first remission. A previous study of patients treated in 1980-1987 showed similar leukemia-free survivals with these approaches. We re-examined this issue in more recently treated patients receiving different chemotherapy. Chemotherapy subjects (n = 76) participated in trial ALL-87 of the Japan Adult Leukemia Study Group (JALSG). Transplant subjects (n = 214) were reported to the International Bone Marrow Transplant Registry (IBMTR). Treatment-related mortality, relapse and leukemia-free survival were compared after adjusting for differences in subject- and disease-related variables and time-to-treatment. Outcomes differed in persons ≤ and > 30 years of age. Five-year treatment-related mortality in persons ≤ 30 years was 3% (95% confidence interval, 0-12%) with chemotherapy vs 32% (23-41%; P < 0.0001) with transplants. The difference was greater among persons > 30 years, 13% (2-31%) with chemotherapy vs 57% (43-69%; P < 0.0001) with transplants. Five-year relapse probability in persons ≤ 30 years was 69% (50-84%) with chemotherapy vs 22% (14-32%; P < 0.0001) with transplants. Among persons > 30 years, 5-year relapse was 70% (53-85%) with chemotherapy vs 32% (20-45%; P < 0.0001) with transplants. Leukemia-free survival at 5 years was significantly worse with chemotherapy than with transplants in persons ≤ 30 years (30% (15-48%) vs 53% (44-63%; P = 0.02)) but not in persons > 30 years (26% (13-41%) vs 30% (20-41%; P = 0.70)). We concluded that transplants result in more treatment-related deaths but fewer relapses than chemotherapy. Leukemia-free survival is better with transplants than chemotherapy in persons ≤ 30 years of age but comparable in older persons.

Original languageEnglish
Pages (from-to)253-257
Number of pages5
JournalBone Marrow Transplantation
Volume22
Issue number3
DOIs
Publication statusPublished - Jan 1 1998

Keywords

  • Bone marrow transplantation
  • Chemotherapy
  • Leukemia
  • Treatment

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Oh, H., Gale, R. P., Zhang, M. J., Passweg, J. R., Ino, T., Murakami, H., Ohno, R., Rowlings, P. A., Sobocinski, K. A., Tanimoto, M., Tomonaga, M., Weisdorf, D. J., & Horowitz, M. M. (1998). Chemotherapy vs HLA-identical sibling bone marrow transplants for adults with acute lymphoblastic leukemia in first remission. Bone Marrow Transplantation, 22(3), 253-257. https://doi.org/10.1038/sj.bmt.1701316