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A comparative study of combination chemotherapy versus marrow transplant in first remission in adult acute lymphoblastic leukaemia
Author(s) -
Proctor S. J.,
Hamilton P. J.,
Taylor Penny,
Carey P.,
Hargrave S.,
Evans R. G. B.,
Summerfield G.,
Finney R.,
Saunders P.,
Goff D.,
Reid M. M.
Publication year - 1988
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1988.tb07599.x
Subject(s) - medicine , methotrexate , chemotherapy , maintenance therapy , acute lymphocytic leukemia , bone marrow , surgery , complete remission , oncology , radiation therapy , leukemia , lymphoblastic leukemia
Summary. The results of conventional chemotherapy in adult acute lymphoblastic leukaemia (ALL) have not improved substantially in recent years. The present study is based on a flexible policy of marrow transplantation (allograft and autograft without marrow purging) in first remission compared with a group treated with standard maintenance therapy after a common induction sequence. The actuarial disease free survival (DFS) and actuarial overall survival (OS) at 3 years for autologous marrow grafted patients was 30% and 65% respectively. The allogeneic transplant group had DFS of 30% and OS at 3 years of 38% compared with DFS (12%) and OS (12%) for patients on 6‐mercaptopurine and methotrexate maintenance. The actuarial disease free survival calculations include patients on protocol not entering remission, therefore, giving the worst possible result. We conclude that high dose chemo/radiotherapy with autologous marrow rescue in first remission followed by no maintenance provides better results in terms of overall survival and quality of life than standard ALL maintenance in adult patients. Results for allogeneic transplant in ALL are less good in terms of duration and quality of survival and the majority of deaths are related to causes other than leukaemic relapse.