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6-year PFS = 63%

6-year OS = 64%

ALL, acute lymphoblastic leukemia; EFS, even-free survival; OS, overall survival; PFS, pregression-free survival.

ALL, acute lymphoblastic leukemia; EFS, even-free survival; OS, overall survival; PFS, pregression-free survival.

for randomization, only 65 were actually randomized. The 3-year actuarial relapse-free survival rate was 24% for patients receiving conventional consolidation and maintenance therapy, compared with 55% for those receiving high-dose therapy and autologous stem cell transplantation (p = 0.065). The corresponding values for overall survival were 45 and 56% (p = 0.71). The fact that there was a nonsignificant trend for improved relapse-free survival in the transplant arm, but no difference in overall survival, may be due to the fact that some patients who relapsed after conventional dose consolidation therapy were "rescued" by high-dose therapy in second remission.

The role of allogeneic transplantation in first relapse is also unclear. Limited prospectively collected data are available. These were reported in the context of the European randomized trial mentioned above. In this study 12 patients with HLA-identical sibling donors were treated with allogeneic transplantation in first remission. The 3-year actuarial overall survival of 58% for this group is comparable to results in patients receiving autologous transplants. A recent study from the International Bone Marrow Transplant Registry compared outcomes for autologous and allogeneic stem cell transplantation in adult patients with LBL.37 This study included a subset of patients undergoing transplantation in first remission, although this subset was not analyzed separately. Patients undergoing allo-geneic transplantation in this series had a lower relapse rate following transplant, but this was offset by a much higher rate of nonrelapse mortality, resulting in equivalent overall survival in both groups. At present there are, therefore, no data to suggest that allo-geneic transplantation is the optimal approach.

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