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ADULT ACUTE LYMPHOCYTIC LEUKEMIA STUDY TESTING CHEMOTHERAPY AND AUTOLOGOUS AND ALLOGENEIC TRANSPLANTATION

2000; Elsevier BV; Volume: 14; Issue: 6 Linguagem: Inglês

10.1016/s0889-8588(05)70190-8

1558-1977

Anne Thiébaut, Jean Paul Vernant, Laurent Degos, Françoise Huguet, Josy Reiffers, Catherine Sebban, Éric Lepage, Xavier Thomas, D Fière,

Childhood Cancer Survivors' Quality of Life

During the past 20 years, considerable progress has been made in the treatment of children with acute lymphocytic leukemia (ALL), and several large studies have reported cure rates of 50% to 70%. The objective now in treating children is to adjust the intensity of treatment to match the aggressiveness of the disease to minimize eventual side effects.19, 31, 32 The same or similar treatments for ALL in adults have not been as successful: remission rates range from 60% to 80%, but survival rates at 5 years stay between 25% and 35%.5, 7, 14, 17, 21, 24, 25, 26, 27, 28, 35 Although results cannot be compared, numerous studies have claimed a better long-term survival rate where myeloblative therapy is used to consolidate remission.1, 2, 3, 6, 9, 15, 23, 33, 36, 37, 38 Myeloablative treatment with allogeneic bone marrow transplantation (alloBMT) was the most powerful intensified antileukemic therapy for postremission ALL. This therapy, however can be used only in younger patients for whom a donor is available. Also, allogeneic BMT is associated with substantial risks, with a relatively high percentage of deaths related to the procedure. Although less toxic, autologous transplantation (autoBMT) has also been used with varying degress of success. In autoBMT the potential risk of leukemic cell reinfusion must either be disregarded as irrelevant or be addressed by various methods of in vitro therapy. Therefore, the use of transplantation to treat ALL in adult patients with complete remission (CR) remained controversial.12, 30 After pilot studies testing feasibility, the French (Leucémie Aiguë Lymphoblastique de l'Adulte [LALA]) group in 1987 developed a prospective multicentric trial (the LALA 87 trial) to assess the place of alloBMT and of autoBMT in adult ALL.10, 11 Results of the trial have been published already with a relatively short (38 months) median follow-up.4, 11, 16, 34 This article presents the definitive results of the trial with a 10-year follow-up.