TY - JOUR
T1 - Allogeneic stem cell transplantation improves the outcome of adults with t(1;19)/E2A-PBX1 and t(4;11)/MLL-AF4 positive B-cell acute lymphoblastic leukemia
T2 - Results of the prospective multicenter LALA-94 study
AU - Vey, N.
AU - Thomas, X.
AU - Picard, C.
AU - Kovascovicz, T.
AU - Charin, C.
AU - Cayuela, J. M.
AU - Dombret, H.
AU - Dastugue, N.
AU - Huguet, F.
AU - Bastard, C.
AU - Stamatoulas, A.
AU - Giollant, M.
AU - Tournilhac, O.
AU - Macintyre, E.
AU - Buzyn, A.
AU - Bories, D.
AU - Kuentz, M.
AU - Dreyfus, F.
AU - Delannoy, A.
AU - Raynaud, S.
AU - Gratecos, N.
AU - Bordessoule, D.
AU - de Botton, S.
AU - Preudhomme, C.
AU - Reman, O.
AU - Troussard, X.
AU - Pigneux, A.
AU - Bilhou, C.
AU - Vernant, J. P.
AU - Boucheix, C.
AU - Gabert, J.
N1 - Funding Information:
This work was supported in part by PHRC No. 94-95-97-02, Ministère de l’Emploi et de la Solidarité. The authors are indebt to Véronique Lheritier for excellent data management, MC Benet for paper review and to the following investigators of the LALA-94 trials: F Guilhot (CHU Poitiers), X Vallantin (CH Perpignan), N Fégueux (CHU Montpellier), B Souleau (HIA Percy), F Garban (CHU Grenoble), C Caillot (Dijon) and O Boulat (Avignon).
PY - 2006/1/1
Y1 - 2006/1/1
N2 - Adult patients with acute lymphoblastic leukemia (ALL) and t(1;19)/ E2A-PBX1 or t(4;11)/MLL-AF4 have a poor outcome. We have evaluated the impact of an intensified post-remission therapy using a high-dose chemotherapy course followed by allogeneic or autologous SCT on the outcome of 58 patients with t(1;19)/E2A-PBX1 (E2A group, n=24) or t(4;11)/MLL-AF4 (MLL group, n=34) treated in the LALA-94 multicenter prospective study. Patients in the MLL group had higher WBC counts and more frequent DIC. CR rates achieved by MLL and E2A groups were similar to other B-cell ALL (87, 82 and 86% respectively). While in CR, patients with a donor were assigned to alloSCT (n=22), the remaining patients with were randomized between autoSCT (n=15) or chemotherapy (n=8). Five-year overall survival was 31 and 45% for E2A and MLL groups, respectively. In both groups, DFS was higher in the alloSCT arm as compared to autoSCT and chemotherapy arms. The results of this study show that chemotherapy intensification did not overcome the poor prognosis of adults with t(1;19)/E2A-PBX1. Allogeneic SCT should thus be offered in first CR to patients with t(1;19)/E2A-PBX1 or t(4;11)/MLL-AF4. New therapeutic approaches are needed for patients without donor.
AB - Adult patients with acute lymphoblastic leukemia (ALL) and t(1;19)/ E2A-PBX1 or t(4;11)/MLL-AF4 have a poor outcome. We have evaluated the impact of an intensified post-remission therapy using a high-dose chemotherapy course followed by allogeneic or autologous SCT on the outcome of 58 patients with t(1;19)/E2A-PBX1 (E2A group, n=24) or t(4;11)/MLL-AF4 (MLL group, n=34) treated in the LALA-94 multicenter prospective study. Patients in the MLL group had higher WBC counts and more frequent DIC. CR rates achieved by MLL and E2A groups were similar to other B-cell ALL (87, 82 and 86% respectively). While in CR, patients with a donor were assigned to alloSCT (n=22), the remaining patients with were randomized between autoSCT (n=15) or chemotherapy (n=8). Five-year overall survival was 31 and 45% for E2A and MLL groups, respectively. In both groups, DFS was higher in the alloSCT arm as compared to autoSCT and chemotherapy arms. The results of this study show that chemotherapy intensification did not overcome the poor prognosis of adults with t(1;19)/E2A-PBX1. Allogeneic SCT should thus be offered in first CR to patients with t(1;19)/E2A-PBX1 or t(4;11)/MLL-AF4. New therapeutic approaches are needed for patients without donor.
UR - http://www.scopus.com/inward/record.url?scp=33751246497&partnerID=8YFLogxK
U2 - 10.1038/sj.leu.2404420
DO - 10.1038/sj.leu.2404420
M3 - Article
AN - SCOPUS:33751246497
SN - 0887-6924
VL - 20
SP - 2155
EP - 2161
JO - Leukemia
JF - Leukemia
IS - 12
ER -