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Long-Term Follow-up of Adults with Acute Lymphoblastic Leukemia in First Remission Treated with Chemotherapy or Bone Marrow Transplantation

Mei-Jie Zhang, PhD; Dieter Hoelzer, MD; Mary M. Horowitz, MD, MS; Robert Peter Gale, MD, PhD; Dorle Messerer, PhD; John P. Klein, PhD; Helmut Löffler, MD; Kathleen A. Sobocinski, MS; Eckhard Thiel, MD; and Daniel J. Weisdorf, MD, for the Acute Lymphoblastic Leukemia Working Committee
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From the Medical College of Wisconsin, Milwaukee, Wisconsin; Johann Wolfgang Goethe University, Frankfurt, Germany; Salick Health Care, Inc., Los Angeles, California; Biometric Center for Therapeutic Studies, Munich, Germany; University of Kiel, Kiel, Germany; University of Berlin, Berlin, Germany; and University of Minnesota, Minneapolis, Minnesota. Acknowledgments: The authors thank Sharon Nell, Beverly Bodine, and D'Etta Waldoch-Koser for help with data collection and analysis and Lisa J. Schneider for manuscript preparation. Grant Support: In part by Public Health Service Grant PO1-CA-40053 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung, and Blood Institute. Also by grants from Alpha Therapeutic Corporation; Armour Pharmaceutical Company; Astra Pharmaceutical; Baxter Healthcare Corporation; Biogen; Lynde and Harry Bradley Foundation; Bristol-Myers Squibb Company; Frank G. Brotz Family Foundation; Burroughs-Wellcome Company; Center for Advanced Studies in Leukemia; Charles E. Culpeper Foundation; Eleanor Naylor Dana Charitable Trust; Eppley Foundation for Research; Immunex Corporation; Kettering Family Foundation; Kirin Brewery Company; Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation; Herbert H. Kohl Charities, Inc.; Eli Lilly Company Foundation; Nada and Herbert P. Mahler Charities; Marion Merrell Dow, Inc.; Milstein Family Foundation; Milwaukee Foundation/Elsa Schoeneich Research Fund; Samuel Roberts Noble Foundation; Ortho Biotech Corporation; John Oster Family Foundation; Elsa U. Pardee Foundation; Jane and Lloyd Pettit Foundation; Pharmacia; RGK Foundation; Roerig/Pfizer Pharmaceuticals; Sandoz Pharmaceuticals; Walter Schroeder Foundation; Stackner Family Foundation; Starr Foundation; Joan and Jack Stein Charities; and Wyeth-Ayerst Laboratories. Requests for Reprints: Dr. Mary M. Horowitz, International Bone Marrow Transplant Registry, Medical College of Wisconsin, PO Box 26509, 8701 Watertown Plank Road, Milwaukee, WI 53226. Current Author Addresses: Drs. Zhang, Horowitz, and Sobocinski: International Bone Marrow Transplant Registry, PO Box 26509, 8701 Watertown Plank Road, Milwaukee, WI 53226.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(6):428-431. doi:10.7326/0003-4819-123-6-199509150-00006
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Objective: To determine whether the conclusions of a 1991 study, which showed that adults with acute lymphoblastic leukemia in first remission had similar leukemia-free survival rates when treated with chemotherapy or HLA-identical sibling bone marrow transplantation, remain valid after more than 4 years of additional follow-up.

Design: Retrospective comparison of two cohorts of patients using left-truncated Cox regression to adjust for differences in baseline characteristics and time to treatment.

Setting and Patients: Chemotherapy recipients were 484 consecutive patients with acute lymphoblastic leukemia in first remission treated in 44 hospitals in Germany that were participating in two consecutive trials of the German Acute Lymphoblastic Leukemia Therapy Trials Group. Transplant recipients were 234 consecutive recipients of HLA-identical sibling bone marrow transplants for acute lymphoblastic leukemia in first remission in 98 centers, worldwide, reporting data to the International Bone Marrow Transplant Registry.

Interventions: Intensive combination chemotherapy or HLA-identical sibling bone marrow transplantation preceded by high-dose chemotherapy with or without total body irradiation.

Measurements: Relapse, treatment-related mortality, and leukemia-free survival rate 9 years after first complete remission.

Results: The conclusions of our previous analyses were confirmed. Actuarial relapse probabilities at 9 years were 66% (95% CI, 61% to 70%) for chemotherapy and 30% (CI, 22% to 37%) for transplantation (P < 0.0001). The leukemia-free survival rates at 9 years were 32% (CI, 27% to 37%) for chemotherapy and 34% (CI, 28% to 40%) for transplantation (P < 0.02).

Conclusions: Fewer relapses but more treatment-related deaths were seen with transplantation than with chemotherapy. Thus, leukemia-free survival rates were similar in adults receiving transplantation and adults receiving chemotherapy for acute lymphoblastic leukemia in first remission.





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