Management of adult patients with acute lymphoblastic leukemia in first complete remission

Systematic review and meta-analysis

Authors

  • Ron Ram MD,

    1. Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
    2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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    • The first 2 authors contributed equally to this article.

  • Anat Gafter-Gvili MD,

    1. Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
    2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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    • The first 2 authors contributed equally to this article.

  • Liat Vidal MD,

    1. Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
    2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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  • Mical Paul MD,

    1. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
    2. Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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  • Isaac Ben-Bassat MD,

    1. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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  • Ofer Shpilberg MD, MPH,

    1. Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
    2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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  • Pia Raanani MD

    Corresponding author
    1. Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
    2. Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
    • Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tikva 49100, Israel
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    • Fax: (011) 972-3-9378130


Abstract

BACKGROUND:

The optimal postremission therapy in adults with acute lymphoblastic leukemia (ALL) is still a matter of debate. The objective of this study was to compare the various potential therapeutic options for patients who achieved first complete remission.

METHODS:

The authors conducted a systematic review and meta-analysis of randomized trials, including patients with standard-risk (SR) All and high-risk (HR) ALL who received first postremission therapy. Outcomes assessed were all-cause mortality (ACM), disease recurrence (relapse), and nonrelapse mortality (NRM). Relative risks (RRs) with 95% confidence intervals (CIs) were estimated and pooled.

RESULTS:

Overall, there was a significant reduction in ACM in the allogenic stem cell transplantation (alloSCT) arm (RR, 0.88; 95% CI, 0.8-0.97) compared with autologous stem cell transplantation (ASCT) or chemotherapy. Subgroup analyses revealed a similar pattern among SR patients (RR, 0.8; 95% CI, 0.68-0.94) but a nonsignificant advantage for alloSCT among HR patients (RR, 0.88; 95% CI, 0.76-1.01). There was an increase in NRM (RR, 2.99; 95% CI, 1.37-6.53) and a decrease in the relapse rate in the alloSCT arm (RR, 0.52; 95% CI, 0.33-0.83). There was no difference in ACM or the relapse rate between the ASCT and chemotherapy arms.

CONCLUSIONS:

Overall, alloSCT was superior to ASCT or chemotherapy for patients with ALL in first complete remission. The survival advantage was of greater statistical significance for patients with SR ALL than for patients with HR ALL. Cancer 2010. © 2010 American Cancer Society.

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