Allogeneic transplant may be best postremission therapy for ALL

The results of a meta-analysis indicate that treating patients with acute lymphoblastic leukemia in first complete remission with allogeneic stem cell transplantation instead of autologous transplantation or chemotherapy may be the best therapeutic option.

According to background information in the study, published in Cancer, there is no consensus on the appropriate treatment regimen for these patients in first complete remission. Patients may either undergo hematopoietic stem cell transplantation or be treated with conventional chemotherapy. Although an American Society of Blood and Marrow Transplantation position paper recommends transplantation, other meta-analyses have found that these patients have better survival outcomes when treated with allogeneic transplantation.

To research this topic further, Ron Ram, MD, of the Sackler School of Medicine, Tel Aviv University, Israel, and colleagues conducted a systematic review and meta-analysis of both standard-risk and high-risk patients with ALL who underwent postremission therapy.

The analysis included data from 13 trials that included 2,648 patients. The trials were conducted between 1986 and 2006.

Data indicated that patients who underwent allogeneic transplantation had a significant reduction in all-cause mortality compared with those who underwent chemotherapy or autologous transplantation (RR=0.88; 95% CI, 0.8-0.97). A subgroup analysis of patients according to risk group indicated that this held true in standard-risk patients (RR=0.8; 95% CI, 0.68-0.94), but was not statistically significant in high-risk patients (RR=0.88; 95% CI, 0.76-1.01).

Allogeneic transplantation also conferred a benefit in regard to nonrelapse mortality (RR=2.99; 95% CI, 1.37-6.53) and recurrence rate (RR=0.52; 95% CI, 0.33-0.83).

When comparing all-cause mortality between patients who underwent chemotherapy or autologous transplantation, no difference was found overall, or in a subgroup analysis of standard- and high-risk patients.

Ram R. Cancer. 2010;doi:10.1002/cncr.25136.