Outcome of treatment in adults with acute lymphoblastic leukemia: Analysis of the LALA-94 trial
Identifieur interne : 00AB61 ( Main/Exploration ); précédent : 00AB60; suivant : 00AB62Outcome of treatment in adults with acute lymphoblastic leukemia: Analysis of the LALA-94 trial
Auteurs : Xavier Thomas [France, Suisse, Belgique, Australie] ; Jean-Michel Boiron ; Francoise Huguet ; Hervé Dombret ; Ken Bradstock ; Norbert Vey ; Tibor Kovacsovics ; André Delannoy ; Nathalie Fegueux ; Pierre Fenaux ; Aspasia Stamatoullas ; Jean-Paul Vernant ; Olivier Tournilhac ; Agnès Buzyn ; Oumedaly Reman ; Christiane Charrin ; Claude Boucheix ; Jean Gabert ; Véronique Lheritier ; Denis FiereSource :
- Journal of clinical oncology [ 0732-183X ] ; 2004.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Adulte.
English descriptors
- KwdEn :
Abstract
Purpose We analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia (ALL), and re-evaluated stem-cell transplantation (SCT) for high-risk ALL. Patients and Methods A total of 922 adult patients entered onto the trial according to risk groups: standard-risk ALL (group 1), high-risk ALL (group 2), Philadelphia chromosome-positive ALL (group 3), and CNS-positive ALL (group 4). All received a standard four-drug/4-week induction course. Patients from group 1 who achieved a complete remission (CR) after one course of induction therapy were randomly assigned between intensive and less intensive postremission chemotherapy, whereas those who achieved CR after salvage therapy were then included in group 2. Patients in groups 2, 3, and 4 with an HLA-identical sibling were assigned to allogeneic SCT. In groups 3 and 4, autologous SCT was offered to all other patients, whereas in group 2 they were randomly assigned between chemotherapy and autologous SCT. Results Overall, 771 patients achieved CR (84%). Median disease-free survival (DFS) was 17.5 months, with 3-year DFS at 37%. In group 1, the 3-year DFS rate was 41%, with no difference between arms of postremission randomization. In groups 2 and 4, the 3-year DFS rates were 38% and 44%, respectively. In group 2, autologous SCT and chemotherapy resulted in comparable median DFS. Patients with an HLA-matched sibling (groups 2 and 4) had improved DFS. Three-year DFS was 24% in group 3. Conclusion Allogeneic SCT improved DFS in high-risk ALL in the first CR. Autologous SCT did not confer a significant benefit over chemotherapy for high-risk ALL.
Affiliations:
- Australie, Belgique, France, Suisse
- Auvergne (région administrative), Auvergne-Rhône-Alpes, Basse-Normandie, Canton de Vaud, Haute-Normandie, Languedoc-Roussillon, Midi-Pyrénées, Occitanie (région administrative), Provence-Alpes-Côte d'Azur, Rhône-Alpes, Région Normandie, Île-de-France
- Caen, Clermont-Ferrand, Lausanne, Lyon, Marseille, Montpellier, Paris, Rouen, Toulouse
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Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Hôpital Edouard Herriot</s1><s2>Lyon</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Lyon</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Hôpital du Haut Levêque</s1><s2>Pessac</s2><s3>FRA</s3></inist:fA14><country>France</country><wicri:noRegion>Pessac</wicri:noRegion><wicri:noRegion>Hôpital du Haut Levêque</wicri:noRegion><wicri:noRegion>Hôpital du Haut Levêque</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Hôpital Purpan</s1><s2>Toulouse</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Midi-Pyrénées</region><settlement 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type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Institut Paoli Calmettes</s1><s2>Marseille</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Centre Hospitalier Lapeyconle</s1><s2>Montpellier</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Occitanie (région administrative)</region><region type="old region">Languedoc-Roussillon</region><settlement type="city">Montpellier</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Centre Hospitalier, Centre Henri Becquerel</s1><s2>Rouen</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Région Normandie</region><region type="old region">Haute-Normandie</region><settlement type="city">Rouen</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Hôtel-Dieu</s1><s2>Clermont-Ferrand</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Auvergne (région administrative)</region><settlement type="city">Clermont-Ferrand</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="11"><s1>Centre Hospitalier</s1><s2>Caen</s2><s3>FRA</s3></inist:fA14><country>France</country><placeName><region type="region">Région Normandie</region><region type="old region">Basse-Normandie</region><settlement type="city">Caen</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>L'Institut National de le Sonté et de la Recherche Médicale U288</s1><s2>Villejuif</s2><s3>FRA</s3></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>L'Institut National de le Sonté et de la Recherche Médicale U288</wicri:noRegion><wicri:noRegion>L'Institut National de le Sonté et de la Recherche Médicale U288</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="13"><s1>Centre Hospiteller Universitaire Vaudois</s1><s2>Lausanne</s2><s3>CHE</s3></inist:fA14><country>Suisse</country><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Hôpital de Jolimont</s1><s2>Haine St Paul</s2><s3>BEL</s3></inist:fA14><country>Belgique</country><wicri:noRegion>Hôpital de Jolimont</wicri:noRegion></affiliation><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Westmead Hospital</s1><s2>Westmead</s2><s3>AUS</s3></inist:fA14><country>Australie</country><wicri:noRegion>Westmead Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Boiron, Jean Michel" sort="Boiron, Jean Michel" uniqKey="Boiron J" first="Jean-Michel" last="Boiron">Jean-Michel Boiron</name></author><author><name sortKey="Huguet, Francoise" sort="Huguet, Francoise" uniqKey="Huguet F" first="Francoise" last="Huguet">Francoise Huguet</name></author><author><name sortKey="Dombret, Herve" sort="Dombret, Herve" uniqKey="Dombret H" first="Hervé" last="Dombret">Hervé Dombret</name></author><author><name sortKey="Bradstock, Ken" sort="Bradstock, Ken" uniqKey="Bradstock K" first="Ken" last="Bradstock">Ken Bradstock</name></author><author><name sortKey="Vey, Norbert" sort="Vey, Norbert" uniqKey="Vey N" first="Norbert" last="Vey">Norbert Vey</name></author><author><name sortKey="Kovacsovics, Tibor" sort="Kovacsovics, Tibor" uniqKey="Kovacsovics T" first="Tibor" last="Kovacsovics">Tibor Kovacsovics</name></author><author><name sortKey="Delannoy, Andre" sort="Delannoy, Andre" uniqKey="Delannoy A" first="André" last="Delannoy">André Delannoy</name></author><author><name sortKey="Fegueux, Nathalie" sort="Fegueux, Nathalie" uniqKey="Fegueux N" first="Nathalie" last="Fegueux">Nathalie Fegueux</name></author><author><name sortKey="Fenaux, Pierre" sort="Fenaux, Pierre" uniqKey="Fenaux P" first="Pierre" last="Fenaux">Pierre Fenaux</name></author><author><name sortKey="Stamatoullas, Aspasia" sort="Stamatoullas, Aspasia" uniqKey="Stamatoullas A" first="Aspasia" last="Stamatoullas">Aspasia Stamatoullas</name></author><author><name sortKey="Vernant, Jean Paul" sort="Vernant, Jean Paul" uniqKey="Vernant J" first="Jean-Paul" last="Vernant">Jean-Paul Vernant</name></author><author><name sortKey="Tournilhac, Olivier" sort="Tournilhac, Olivier" uniqKey="Tournilhac O" first="Olivier" last="Tournilhac">Olivier Tournilhac</name></author><author><name sortKey="Buzyn, Agnes" sort="Buzyn, Agnes" uniqKey="Buzyn A" first="Agnès" last="Buzyn">Agnès Buzyn</name></author><author><name sortKey="Reman, Oumedaly" sort="Reman, Oumedaly" uniqKey="Reman O" first="Oumedaly" last="Reman">Oumedaly Reman</name></author><author><name sortKey="Charrin, Christiane" sort="Charrin, Christiane" uniqKey="Charrin C" first="Christiane" last="Charrin">Christiane Charrin</name></author><author><name sortKey="Boucheix, Claude" sort="Boucheix, Claude" uniqKey="Boucheix C" first="Claude" last="Boucheix">Claude Boucheix</name></author><author><name sortKey="Gabert, Jean" sort="Gabert, Jean" uniqKey="Gabert J" first="Jean" last="Gabert">Jean Gabert</name></author><author><name sortKey="Lheritier, Veronique" sort="Lheritier, Veronique" uniqKey="Lheritier V" first="Véronique" last="Lheritier">Véronique Lheritier</name></author><author><name sortKey="Fiere, Denis" sort="Fiere, Denis" uniqKey="Fiere D" first="Denis" last="Fiere">Denis Fiere</name></author></analytic><series><title level="j" type="main">Journal of clinical oncology</title><title level="j" type="abbreviated">J. clin. oncol.</title><idno type="ISSN">0732-183X</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of clinical oncology</title><title level="j" type="abbreviated">J. clin. oncol.</title><idno type="ISSN">0732-183X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute</term><term>Acute leukemia</term><term>Acute lymphocytic leukemia</term><term>Adult</term><term>Cancerology</term><term>Clinical trial</term><term>Prognosis</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Leucémie lymphoblastique</term><term>Pronostic</term><term>Traitement</term><term>Adulte</term><term>Essai clinique</term><term>Cancérologie</term><term>Aigu</term><term>Leucémie aigu</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Adulte</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Purpose We analyzed the benefits of a risk-adapted postremission strategy in adult lymphoblastic leukemia (ALL), and re-evaluated stem-cell transplantation (SCT) for high-risk ALL. Patients and Methods A total of 922 adult patients entered onto the trial according to risk groups: standard-risk ALL (group 1), high-risk ALL (group 2), Philadelphia chromosome-positive ALL (group 3), and CNS-positive ALL (group 4). All received a standard four-drug/4-week induction course. Patients from group 1 who achieved a complete remission (CR) after one course of induction therapy were randomly assigned between intensive and less intensive postremission chemotherapy, whereas those who achieved CR after salvage therapy were then included in group 2. Patients in groups 2, 3, and 4 with an HLA-identical sibling were assigned to allogeneic SCT. In groups 3 and 4, autologous SCT was offered to all other patients, whereas in group 2 they were randomly assigned between chemotherapy and autologous SCT. Results Overall, 771 patients achieved CR (84%). Median disease-free survival (DFS) was 17.5 months, with 3-year DFS at 37%. In group 1, the 3-year DFS rate was 41%, with no difference between arms of postremission randomization. In groups 2 and 4, the 3-year DFS rates were 38% and 44%, respectively. In group 2, autologous SCT and chemotherapy resulted in comparable median DFS. Patients with an HLA-matched sibling (groups 2 and 4) had improved DFS. Three-year DFS was 24% in group 3. Conclusion Allogeneic SCT improved DFS in high-risk ALL in the first CR. Autologous SCT did not confer a significant benefit over chemotherapy for high-risk ALL.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>France</li><li>Suisse</li></country><region><li>Auvergne (région administrative)</li><li>Auvergne-Rhône-Alpes</li><li>Basse-Normandie</li><li>Canton de Vaud</li><li>Haute-Normandie</li><li>Languedoc-Roussillon</li><li>Midi-Pyrénées</li><li>Occitanie (région administrative)</li><li>Provence-Alpes-Côte d'Azur</li><li>Rhône-Alpes</li><li>Région Normandie</li><li>Île-de-France</li></region><settlement><li>Caen</li><li>Clermont-Ferrand</li><li>Lausanne</li><li>Lyon</li><li>Marseille</li><li>Montpellier</li><li>Paris</li><li>Rouen</li><li>Toulouse</li></settlement></list><tree><noCountry><name sortKey="Boiron, Jean Michel" sort="Boiron, Jean Michel" uniqKey="Boiron J" first="Jean-Michel" last="Boiron">Jean-Michel Boiron</name><name sortKey="Boucheix, Claude" sort="Boucheix, Claude" uniqKey="Boucheix C" first="Claude" last="Boucheix">Claude Boucheix</name><name sortKey="Bradstock, Ken" sort="Bradstock, Ken" uniqKey="Bradstock K" first="Ken" last="Bradstock">Ken Bradstock</name><name sortKey="Buzyn, Agnes" sort="Buzyn, Agnes" uniqKey="Buzyn A" first="Agnès" last="Buzyn">Agnès Buzyn</name><name sortKey="Charrin, Christiane" sort="Charrin, Christiane" uniqKey="Charrin C" first="Christiane" last="Charrin">Christiane Charrin</name><name sortKey="Delannoy, Andre" sort="Delannoy, Andre" uniqKey="Delannoy A" first="André" last="Delannoy">André Delannoy</name><name sortKey="Dombret, Herve" sort="Dombret, Herve" uniqKey="Dombret H" first="Hervé" last="Dombret">Hervé Dombret</name><name sortKey="Fegueux, Nathalie" sort="Fegueux, Nathalie" uniqKey="Fegueux N" first="Nathalie" last="Fegueux">Nathalie Fegueux</name><name sortKey="Fenaux, Pierre" sort="Fenaux, Pierre" uniqKey="Fenaux P" first="Pierre" last="Fenaux">Pierre Fenaux</name><name sortKey="Fiere, Denis" sort="Fiere, Denis" uniqKey="Fiere D" first="Denis" last="Fiere">Denis Fiere</name><name sortKey="Gabert, Jean" sort="Gabert, Jean" uniqKey="Gabert J" first="Jean" last="Gabert">Jean Gabert</name><name sortKey="Huguet, Francoise" sort="Huguet, Francoise" uniqKey="Huguet F" first="Francoise" last="Huguet">Francoise Huguet</name><name sortKey="Kovacsovics, Tibor" sort="Kovacsovics, Tibor" uniqKey="Kovacsovics T" first="Tibor" last="Kovacsovics">Tibor Kovacsovics</name><name sortKey="Lheritier, Veronique" sort="Lheritier, Veronique" uniqKey="Lheritier V" first="Véronique" last="Lheritier">Véronique Lheritier</name><name sortKey="Reman, Oumedaly" sort="Reman, Oumedaly" uniqKey="Reman O" first="Oumedaly" last="Reman">Oumedaly Reman</name><name sortKey="Stamatoullas, Aspasia" sort="Stamatoullas, Aspasia" uniqKey="Stamatoullas A" first="Aspasia" last="Stamatoullas">Aspasia Stamatoullas</name><name sortKey="Tournilhac, Olivier" sort="Tournilhac, Olivier" uniqKey="Tournilhac O" first="Olivier" last="Tournilhac">Olivier Tournilhac</name><name sortKey="Vernant, Jean Paul" sort="Vernant, Jean Paul" uniqKey="Vernant J" first="Jean-Paul" last="Vernant">Jean-Paul Vernant</name><name sortKey="Vey, Norbert" sort="Vey, Norbert" uniqKey="Vey N" first="Norbert" last="Vey">Norbert Vey</name></noCountry><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name></region><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name></country><country name="Suisse"><region name="Canton de Vaud"><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name></region></country><country name="Belgique"><noRegion><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Thomas, Xavier" sort="Thomas, Xavier" uniqKey="Thomas X" first="Xavier" last="Thomas">Xavier Thomas</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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