The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Acute Lymphoblastic Leukemia in Adults: An Evidence-based.

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Presentation transcript:

The Role of Cytotoxic Therapy with Hematopoietic Stem Cell Transplantation in the Therapy of Acute Lymphoblastic Leukemia in Adults: An Evidence-based Review  Theresa Hahn, Donna Wall, Bruce Camitta, Stella Davies, Hildy Dillon, Paul Gaynon, Richard A. Larson, Susan Parsons, Jerome Seidenfeld, Daniel Weisdorf, Philip L. McCarthy  Biology of Blood and Marrow Transplantation  Volume 12, Issue 1, Pages 1-30 (January 2006) DOI: 10.1016/j.bbmt.2005.10.018 Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 DFS according to the administration of autologous BMT or chemotherapy. BMT: total 96, dead 63; censored, 33. Chemotherapy: total, 95, dead 58; censored, 47. (P=.8). Reprinted with permission [5]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Disease-free survival (DFS) according to second randomization for patients in group 2 (70 patients in the autologous stem-cell transplantation [SCT] arm and 59 patients in the chemotherapy arm). CR, complete remission. Reprinted with permission [7]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Disease-free survival (DFS) according to genetic randomization. For this analysis, patients from group 2 (211 patients) and those from group 4 (48 patients) were pooled. The group with a sibling donor comprised 100 patients, whereas that with no sibling donor included 159 patients. CR, complete remission. Reprinted with permission [7]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Overall survival of patients with high-risk leukemia according to allocation arm. (Solid line BMT; dashed line control). Reprinted with permission [6]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 Kaplan-Meier estimation of disease-free survival in patients receiving transplantation from a matched related or unrelated donor in first complete remission. Reprinted with permission [56]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 6 Overall survival according to alloBMT and autoBMT in an intent-to-treat analysis. Reprinted with permission [66]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 7 DFS was significantly superior (P < .001) for patients with an HLA-identical sibling (dashed line) than for patients without an HLA-identical sibling (solid line). Reprinted with permission [67]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 8 Kaplan-Meier landmark survival estimates (with a 90-day landmark period) for patients eligible for SCT according to the existence of an allogeneic donor (N = 103 patients) (relative risk in the no-donor group, 1.71; 95% confidenced interval, 1.09 to 2.68; P = .02 by the log-rank test). Reprinted with permission [8]. Biology of Blood and Marrow Transplantation 2006 12, 1-30DOI: (10.1016/j.bbmt.2005.10.018) Copyright © 2006 American Society for Blood and Marrow Transplantation Terms and Conditions