| Autor: |
Martin S. Tallman, Peter H. Wiernik, Ian M. Franklin, Hillard J. Lazarus, H. G. Prentice, Alan Kenneth Burnett, Mark R. Litzow, G Harrison, Sue Richards, R Chopra, Jill Durrant, Jacob M. Rowe, Anthony H. Goldstone |
| Rok vydání: |
2016 |
| Předmět: |
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| Popis: |
In 1993 we initiated an International study in newly diagnosed adults with ALL (aged 15 to 55 years). 1508 eligible patients were entered before 31st October 2003 and achieved a complete remission (CR) rate of 91%. 551 patients underwent transplant in 1st CR: 321 matched family donor (MFD), 149 autograft, 67 matched unrelated donor (MUD) and 14 other/unknown. The auto transplant group include all transplants, both randomised and elected. Median time from the start of induction to transplant was 168 days (range 79–1726 days). There were few cases of graft failure; 3.7% MFD, 3% auto, 2% MUD (data available in 82% of cases). Overall survival at five years (5y OS) from transplant was 55% (95% confidence interval 49–61%) for MFD patients, 39% (30–47%) for autograft and 46% (33–58%) for MUD. Age related outcome was significant - for MFD 5y OS < 35 years 60% ≥35 years 45% (p=0.004). For auto transplant Conclusions Transplant related mortality remains significant in the allogeneic setting and is age related. Auto transplant is a safe procedure and remains under serious consideration for 1st CR patients without a MFD. There may be some survival advantage for patients well enough to receive a transplant post-relapse, but this is only likely to benefit a tiny minority of patients. Data from this large ongoing trial of over 1500 patients indicates that it is more important to prevent initial relapse rather than to rely on salvage treatment after relapse. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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