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Chemotherapy Compared with Bone Marrow Transplantation for Adults with Acute Lymphoblastic Leukemia in First Remission

Mary M. Horowitz, MD; Dorle Messerer, PhD; Dieter Hoelzer, MD; Robert Peter Gale, MD, PhD; Albrecht Neiss, PhD; Kerry Atkinson, MD; A. John Barrett, MD; Thomas Büchner, MD; Mathias Freund, MD; Gerhard Heil, MD; Wolfgang Hiddemann, MD; Hans-Jochem Kolb, MD; Helmut Löffler, MD; Alberto M. Marmont, MD; Georg Maschmeyer, MD; Alfred A. Rimm, PhD; Ciril Rozman, MD; Kathleen A. Sobocinski, MS; Bruno Speck, MD; Eckhard Thiel, MD; Daniel J. Weisdorf, MD; Ferry E. Zwaan, MD, PhD; and Mortimer M. Bortin, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by Public Health Service grant CA 40053 from the National Cancer Institute; Public Health Service Contract NO1-A1-62530 from the National Institute of Allergy and Infectious Diseases; Contracts 01 ZW 124/NT, 01 ZP 060, 01 ZW 0349 and 01 ZW 85010 from the Bundesministerium für Forschung und Technologie, FRG; and grants from Bristol-Myers, Burroughs-Wellcome Company, Charles E. Culpeper Foundation, Cutter Biological, Deborah J. Dearholt Memorial Fund, Immunex Corporation, Robert J Kleberg, Jr. and Helen C. Kleberg Foundation, Eli Lily Company, Ambrose Monell Foundation, Northwestern Mutual Life Insurance Company, Ortho Biotech, Elsa U. Pardee Foundation, RGK Foundation, Roerig (a division of Pfizer Pharmaceuticals), Sandoz Research Institute, Stackner Family Foundation Inc., Joan and Jack Stein, the Swiss Cancer League, and Xoma Corporation.

Requests for Reprints: Mary M. Horowitz, MD, International Bone Marrow Transplant Registry, Medical College of Wisconsin, P.O. Box 26509, Milwaukee, WI 53226.

Current Author Addresses: Dr. Horowitz: International Bone Marrow Transplant Registry, 8701 Watertown Plank Road, Milwaukee, WI 53226.

Dr. Messerer: Biometrisches Zentrum für Therapiestudien GmbH, Pettenkoferstrasse 35, D-8000 Munchen 2, Germany.

Dr. Hoelzer: Zentrum der Inneren Medizin, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-6000 Frankfurt, Germany.

Dr. Gale: Division of Hematology/Oncology, UCLA School of Medicine, 42-121 Center for the Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90024-1678.

Dr. Neiss: Institut für Biostatistik und Dokumentation, Universitat Innsbruck, A-6020 Innsbruck, Schöpfstrasse 41/1, Austria.

Dr. Atkinson: St. Vincent's Hospital, Victoria Street, Darlinghurst, N.S.W. 2010, Australia.

Dr. Barrett: Department of Haematology, The Royal Postgraduate Medical School, DuCane Road, London W12 OHS, England.

Dr. Büchner: Department of Internal Medicine, Division of Hematology/Oncology, University of Münster, Medizinische Klinik, Albert Schweitzer Strasse 33, D-4400 Münster, Germany.

Dr. Freund: Medical School of Hannover, Interdisciplinary Unit of Bone Marrow Transplantation, D-3000 Hannover, Germany.

Dr. Heil: Abt. Innere Medizin III, Medizinische Universitätsklinik und Poliklinik, Robert-Koch-Strasse 8, D-7900 Ulm, Germany.

Dr. Hiddemann: Division of Hematology/Oncology, Medizinische Klinik, University of Münster, Albert Schweitzer Strasse 33, D-4400 Münster, Germany.

Dr. Kolb: Medizinische Klinik III, Klinikum Grosshadern, Universitat Muenchen, Marchioninistrasse 15, 8000 Munich 70, Germany.

Dr. Löffler: Department of Immunology, University of Kiel, Brunswiker Strasse 4, D-2300 Kiel, Germany.

Dr. Marmont: Divisione di Ematologia e di Immunologia Clinica, Ospedale San Martino, Viale Benedetto SV, 16132 Genoa, Italy.

Dr. Maschmeyer: Ev. Krankenhaus Essen Werden, Pattbergstrasse 1-3, D-4300, Essen, Germany.

Dr. Rimm: Division of Biostatistics and Clinical Epidemiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226.

Dr. Rozman: Escuela de Hematologia Hospital Clinic, Universidad de Barcelona, Villarroel 170-08036, Barcelona-36, Spain.

Ms. Sobocinski: International Bone Marrow Transplant Registry, 8701 Watertown Plank Road, Milwaukee, WI 53226. Dr. Speck: Med Universitatsklinik, Kantonsspital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Thiel: Freie University of Berlin, Klinikum Steglitz, Department of Hematology/Oncology, D-1000, Berlin 45, Germany.

Dr. Weisdorf: Division of Hematology, University of Minnesota, Twin Cities Campus, 516 Delaware Street SE, Minneapolis, MN 55455.

Dr. Zwaan: Division of Haematology/BMT, Riyadh Armed Forces Hospital, P.O. Box 11159, Saudi Arabia.

Dr. Bortin: International Bone Marrow Transplant Registry, 8701 Watertown Plank Road, Milwaukee, WI 53226.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(1):13-18. doi:10.7326/0003-4819-115-1-13
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Objective: To compare efficacy of intensive postremission chemotherapy with allogeneic bone marrow transplantation in adults with acute lymphoblastic leukemia (ALL) in first remission.

Design: Retrospective comparison of two cohorts of patients.

Setting: Chemotherapy recipients were treated in 44 hospitals in West Germany in two cooperative group trials; transplants were done in 98 hospitals worldwide.

Patients: Patients (484) receiving intensive postremission chemotherapy and 251 recipients of HLA-identical sibling bone marrow transplants for ALL in first remission. Patients ranged from 15 to 45 years of age and were treated between 1980 and 1987.

Main Results: Similar prognostic factors predicted treatment failure (non-T-cell phenotype, high leukocyte count at diagnosis, and 8 or more weeks to achieve first remission) of both therapies. After statistical adjustments were made for differences in disease characteristics and time-to-treatment, survival was similar in the chemotherapy and transplant cohorts: Five-year leukemia-free survival probability was 38% (95% Cl, 33% to 43%) with chemotherapy and 44% (Cl, 37% to 52%) with transplant. No specific prognostic group had a significantly better outcome with one treatment compared with the other (6% for the difference; Cl, - 3% to 15%). Causes of treatment failure differed: With chemotherapy, 268 (96%) failures were from relapse and 11 (4%) were treatment-related; with transplants, 43 (32%) failures were from relapse and 92 (68%) were treatment-related.

Conclusions: These results suggest that bone marrow transplants currently offer no special advantage over chemotherapy for adults with acute lymphoblastic leukemia in first remission.





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