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93% CR

7-year actuarial DFS = 62%

7-year actuarial OS = 51%

ALL, acute lymphoblastic leukemia; FFS, failure-free survival; RFS, relapse-free survival; OS, overall survival; CR, complete remission; PR, partial remission.

ALL, acute lymphoblastic leukemia; FFS, failure-free survival; RFS, relapse-free survival; OS, overall survival; CR, complete remission; PR, partial remission.

transplantation in first remission, in an attempt to reduce the relatively high rate of relapse after induction therapy.23'34-36

Reported results of this approach, summarized in Table 56.3, have appeared superior to those achieved with conventional dose consolidation and maintenance chemotherapy. Long-term disease-free survival in most of these series has been between 60 and 80%, but most of these studies have conducted survival analyses from the date of stem cell transplantation, and have therefore selected for patients who respond to initial induction therapy, and who are likely to represent a more favorable group. Very few of these studies have included a true intent to treat analysis. One such study has been reported by Jost et al. in which all patients were followed from the date of diagnosis. The 3-year actuarial overall and event-free survival rates were 48 and 31%, respectively.35 These results are comparable to those reported for conventional dose first-line therapy.

A small randomized trial has compared the use of high-dose therapy and autologous stem cell transplantation with conventional dose consolidation and maintenance therapy as postremission therapy in adult patients with LBL.7 This study included 119 adult patients who were treated with intensive induction therapy, 111 of whom were assessable for response. The overall response rate was comparable to other series, at 82%. However, of 98 patients eligible

Table 56.3 Results of first remission stem cell transplantation in adults with lymphoblastic lymphoma

Reference

Induction therapy/High-dose regimen/stem cell source

Number of patients

Failure-free survival/ relapse-free survival

Overall survival

Bouabdallah23

Various ALL-type induction regimens/ High-dose cyclophosphamide and TBI/ allogeneic and autologous BMT

62 (30 received bone marrow transplant in first CR)

5 year EFS = 58%

5 year OS = 60%

Verdonck34

CHOP or ALL-like induction/high-dose cyclophosphamide and TBI/autologous BMT

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