Allogeneic, but not autologous, hematopoietic cell transplantation improves survival only among younger adults with acute lymphoblastic leukemia in first remission: an individual patient data meta-analysis
Autor: | Gupta, V, Richards, S, Rowe, J, Büchner, T, Hiddemann, W, Sauerland, C, Amadori, S, Rondelli, R, Testi, Am, Attal, M, Jourdan, E, Reiffers, J, Howman, A, Patel, S, Jacobs, P, Lee, S, Brunet, S, Sierra, J, Alonzo, T, Aplenc, R, Sung, L, Cutler, C, Sun, Z, Tallman, M, Ljungman, P, Labar, B, Willemze, R, Suciu, S, Collette, S, Dombret, H, Thomas, X, Ifrah, N, Hunault-Berger, M, Mandelli, F, Vignetti, M, Tsimberidou, Am, Pagnano, K, da Souza CA, Miranda, Ec, Diaz de Heredia, C, Ortega, Jj, Cornelissen, Jj, van der Holt, B, Oh, H, Takeuchi, J, Kaizer, H, Björkholm, M, Rosenborg, A, Keating, M, Zander, A, Fielding, A, Goldstone, A, Moorman, Av, Bassan, R, Ravindranath, Y, Weinstein, H, Oriol, A, Ribera, Jm, Powles, R, Appelbaum, F, Baker, Luigi, Coltman, C, Crowley, J, Kopecky, K, Messner, H, Akan, H, Beksac, M, Hills, R, Buck, G, Davies, K, Elphinstone, T, Evans, V, Gettins, L, Gregory, C, James, S, Mackinnon, L, Mchugh, T, Morris, P, Wade, R, Wheatley, K. |
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Jazyk: | angličtina |
Rok vydání: | 2013 |
Předmět: |
Oncology
Homologous Adult medicine.medical_specialty Adolescent Age Factors Aged Aged 80 and over Antineoplastic Agents Child Hematopoietic Stem Cell Transplantation Humans Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma Randomized Controlled Trials as Topic Transplantation Autologous Transplantation Homologous Young Adult Hematology Biochemistry Cell Biology Immunology medicine.medical_treatment Hematopoietic stem cell transplantation law.invention Randomized controlled trial law Acute lymphocytic leukemia Internal medicine 80 and over Medicine Young adult Chemotherapy Transplantation Lymphoid Neoplasia business.industry Absolute risk reduction medicine.disease Surgery Adult Acute Lymphoblastic Leukemia business Autologous |
Zdroj: | Blood. 121(2) |
ISSN: | 1528-0020 0006-4971 |
Popis: | Hematopoietic cell transplantation (HCT) and prolonged chemotherapy are standard postremission strategies for adult acute lymphoblastic leukemia in first complete remission, but the optimal strategy remains controversial. There are no randomized trials of allogeneic HCT. In the present study, updated individual patient data were collected and analyzed from studies with information on availability of matched sibling donor (used to mimic randomization) and from randomized trials of autograft versus chemotherapy. Data from 13 studies including 2962 patients, excluding Philadelphia chromosome–positive patients, showed a survival benefit for having a matched sibling donor for patients < 35 years of age (OR = 0.79; 95% CI, 0.70-0.90, P = .0003) but not for those ≥ 35 years of age (OR = 1.01; 95% CI, 0.85-1.19, P = .9; heterogeneity P = .03) because of the higher absolute risk of nonrelapse mortality for older patients. No differences were seen by risk group. There was a trend toward inferior survival for autograft versus chemotherapy (OR = 1.18; 95% CI, 0.99-1.41; P = .06). No beneficial effect of autografting was seen compared with chemotherapy in this analysis. We conclude that matched sibling donor myeloablative HCT improves survival only for younger patients, with an absolute benefit of approximately 10% at 5 years. Improved chemotherapy outcomes and reduced nonrelapse mortality associated with allogeneic HCT may change the relative effects of these treatments in the future. |
Databáze: | OpenAIRE |
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