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.
Bibliographical noteFunding Information:
This work was supported by Public Health Service grant P01-CA-40053 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute of the US Department of Health and Human Services; and grants from the Kirin Brewery Company; Alpha Therapeutic Corporation; Amgen, Inc.; Anonymous; Baxter Healthcare Corporation; Bayer Corporation; Berlex Laboratories; Blue Cross and Blue Shield Association; Lynde and Harry Bradley Foundation; Bristol-Myers Squibb Company; CellPro, Inc; Centeon; Center for Advanced Studies in Leukemia; Chimeric Therapies, Inc; Chiron Therapeutics; Charles E Culpeper Foundation; Eleanor Naylor Dana Charitable Trust; Eppley Foundation for Research; Genentech, Inc; Glaxo Wellcome Company; ICN Pharmaceuticals; Immunex Corporation; Kettering Family Foundation; Robert J Kleberg Jr. and Helen C Kleberg Foundation; Herbert H Kohl Charities, Inc; Nada and Herbert P Mahler Charities; NeXstar Pharmaceuticals, Inc; Milstein Family Foundation; Milwaukee Foundation/Elsa Schoeneich Research Fund; Samuel Roberts Noble Foundation; Novartis Pharmaceuticals; Ortho Biotech Corporation; John Oster Family Foundation; Jane and Lloyd Pettit Foundation; Alirio Pfiffer Bone Marrow Transplant Support Association; Pfizer, Inc; Pharmacia and Upjohn; Principal Mutual Life Insurance Company; RGK Foundation; Roche Laboratories; Rockwell Automation Allen Bradley Company; Scher-ing-Plough International; SangStat Medical Corporation; Searle; Stackner Family Foundation; Starr Foundation; Joan and Jack Stein Charities; SyStemix; United Resource Networks; and Wyeth-Ayerst Laboratories.
- Bone marrow transplantation