Management of adult patients with acute lymphoblastic leukemia in first complete remission: Systematic review and meta-analysis

Ron Ram, Anat Gafter-Gvili, Liat Vidal, Mical Paul, Isaac Ben-Bassat, Ofer Shpilberg, Pia Raanani

Research output: Contribution to journalArticlepeer-review

54 Scopus citations

Abstract

BACKGROUND: The optimal postremission therapy in adults with acute lymphoblastic leukemia (ALL) is still a matter of debate. The objective of this study was to compare the various potential therapeutic options for patients who achieved first complete remission. METHODS: The authors conducted a systematic review and meta-analysis of randomized trials, including patients with standard-risk (SR) All and high-risk (HR) ALL who received first postremission therapy. Outcomes assessed were all-cause mortality (ACM), disease recurrence (relapse), and nonrelapse mortality (NRM). Relative risks (RRs) with 95% confidence intervals (CIs) were estimated and pooled. RESULTS: Overall, there was a significant reduction in ACM in the allogenic stem cell transplantation (alloSCT) arm (RR, 0.88; 95% CI, 0.8-0.97) compared with autologous stem cell transplantation (ASCT) or chemotherapy. Subgroup analyses revealed a similar pattern among SR patients (RR, 0.8; 95% CI, 0.68-0.94) but a nonsignificant advantage for alloSCT among HR patients (RR, 0.88; 95% CI, 0.76-1.01). There was an increase in NRM (RR, 2.99; 95% CI, 1.37-6.53) and a decrease in the relapse rate in the alloSCT arm (RR, 0.52; 95% CI, 0.33-0.83). There was no difference in ACM or the relapse rate between the ASCT and chemotherapy arms. CONCLUSIONS: Overall, alloSCT was superior to ASCT or chemotherapy for patients with ALL in first complete remission. The survival advantage was of greater statistical significance for patients with SR ALL than for patients with HR ALL.

Original languageEnglish
Pages (from-to)3447-3457
Number of pages11
JournalCancer
Volume116
Issue number14
DOIs
StatePublished - 15 Jul 2010
Externally publishedYes

Keywords

  • Acute lymphoblastic leukemia
  • Allogeneic transplantation
  • Autologous stem cell transplantation
  • Chemotherapy
  • First complete remission

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