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Prospective data on the value of allogeneic hematopoietic stem cell transplantation (alloHSCT) in Philadelphia chromosome-positive (Ph(+)) acute lymphoblastic leukemia (ALL) are limited. The UKALLXII/ECOG 2993 study evaluated the outcome of assigning alloHSCT with a sibling (sib) or matched unrelated donor (MUD) to patients younger than 55 years of age achieving complete remission (CR). The CR rate of 267 patients, median age 40, was 82%. Twenty-eight percent of patients proceeded to alloHSCT in first CR. Age older than 55 years or a pre-HSCT event were the most common reasons for failure to progress to alloHSCT. At 5 years, overall survival (OS) was 44% after sib alloHSCT, 36% after MUD alloHSCT, and 19% after chemotherapy. After adjustment for sex, age, and white blood count and excluding chemotherapy-treated patients who relapsed or died before the median time to alloHSCT, only relapse-free survival remained significantly superior in the alloHSCT group (odds ratio 0.31, 95% confidence interval 0.16-0.61). An intention-to-treat analysis, using the availability or not of a matched sibling donor, showed 5-year OS to be nonsignificantly better at 34% with a donor versus 25% with no donor. This prospective trial in adult Ph(+) ALL indicates a modest but significant benefit to alloHSCT. This trial has been registered with clinicaltrials.gov under identifier NCT00002514 and as ISRCTN77346223.

Original publication

DOI

10.1182/blood-2009-01-199380

Type

Journal article

Journal

Blood

Publication Date

07/05/2009

Volume

113

Pages

4489 - 4496

Keywords

Adolescent, Adult, Antineoplastic Agents, Benzamides, Female, Hematopoietic Stem Cell Transplantation, Humans, Imatinib Mesylate, Immunophenotyping, Male, Middle Aged, Neoplasm Recurrence, Local, Philadelphia Chromosome, Piperazines, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Prognosis, Prospective Studies, Protein Kinase Inhibitors, Protein-Tyrosine Kinases, Pyrimidines, RNA, Messenger, Remission Induction, Reverse Transcriptase Polymerase Chain Reaction, Survival Rate, Transplantation, Homologous, Treatment Outcome, Young Adult