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Stem Cells

Allogeneic stem cell transplantation improves the outcome of adults with t(1;19)/E2A-PBX1 and t(4;11)/MLL-AF4 positive B-cell acute lymphoblastic leukemia: results of the prospective multicenter LALA-94 study

Leukemia volume 20, pages 2155–2161 (2006)Cite this article

Abstract

Adult patients with acute lymphoblastic leukemia (ALL) and t(1;19)/E2A-PBX1 or t(4;11)/MLL-AF4 have a poor outcome. We have evaluated the impact of an intensified post-remission therapy using a high-dose chemotherapy course followed by allogeneic or autologous SCT on the outcome of 58 patients with t(1;19)/E2A-PBX1 (E2A group, n=24) or t(4;11)/MLL-AF4 (MLL group, n=34) treated in the LALA-94 multicenter prospective study. Patients in the MLL group had higher WBC counts and more frequent DIC. CR rates achieved by MLL and E2A groups were similar to other B-cell ALL (87, 82 and 86% respectively). While in CR, patients with a donor were assigned to alloSCT (n=22), the remaining patients with were randomized between autoSCT (n=15) or chemotherapy (n=8). Five-year overall survival was 31 and 45% for E2A and MLL groups, respectively. In both groups, DFS was higher in the alloSCT arm as compared to autoSCT and chemotherapy arms. The results of this study show that chemotherapy intensification did not overcome the poor prognosis of adults with t(1;19)/E2A-PBX1. Allogeneic SCT should thus be offered in first CR to patients with t(1;19)/E2A-PBX1 or t(4;11)/MLL-AF4. New therapeutic approaches are needed for patients without donor.

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Acknowledgements

This work was supported in part by PHRC No. 94-95-97-02, Ministère de l'Emploi et de la Solidarité. The authors are indebt to Véronique Lheritier for excellent data management, MC Benet for paper review and to the following investigators of the LALA-94 trials: F Guilhot (CHU Poitiers), X Vallantin (CH Perpignan), N Fégueux (CHU Montpellier), B Souleau (HIA Percy), F Garban (CHU Grenoble), C Caillot (Dijon) and O Boulat (Avignon).

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Authors and Affiliations

  1. Département of Hematology, The Institut Paoli-Calmettes, Marseille, France

    N Vey

  2. Département of Transplantation, Hôpital E. Herriot, Lyon, France

    X Thomas & C Charin

  3. Département of Hematology, Hôpital Nord, Marseille, France

    C Picard & J Gabert

  4. Département of Hematology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    T Kovascovicz

  5. Département of Hematology, Hôpital saint Louis, Paris, France

    J M Cayuela & H Dombret

  6. Département of Hematology, Hôpital Purpan, Toulouse, France

    N Dastugue & F Huguet

  7. Département of Hematology, Centre Henri Bequerelle, Rouen, France

    C Bastard & A Stamatoulas

  8. Département of Hematology, Hotel-Dieu, Clermont-Ferrant, France

    M Giollant & O Tournilhac

  9. Département of Hematology, Hôpital Necker, Paris, France

    E Macintyre & A Buzyn

  10. Département of Transplantation, Hôpital Henri Mondor, Creteil, France

    D Bories & M Kuentz

  11. Département of Hematology, Hôpital Cochin, Paris, France

    F Dreyfus

  12. Département of Hematology, Hopital de Jolimont, Haine Saint Paul, Belgium

    A Delannoy

  13. Département of Hematology, Hôpital Larchet, Nice, France

    S Raynaud & N Gratecos

  14. Département of Hematology, Centre Hospitalier, Lille, France

    D Bordessoule, S de Botton & C Preudhomme

  15. Département of Hematology, Centre Hospitalier, Caen, France

    O Reman & X Troussard

  16. Département of Hematology, Hôpital Haut-Levêque, Pessac, France

    A Pigneux & C Bilhou

  17. Département of Hematology, Centre Hospitalier Pitié-Salpêtrière, Paris, France

    J P Vernant

  18. INSERM U268, Villejuif, France

    C Boucheix

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  1. N Vey
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For The GET-LALA Group the Swiss Group for Clinical Cancer Research (SAKK)

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Vey, N., Thomas, X., Picard, C. et al. Allogeneic stem cell transplantation improves the outcome of adults with t(1;19)/E2A-PBX1 and t(4;11)/MLL-AF4 positive B-cell acute lymphoblastic leukemia: results of the prospective multicenter LALA-94 study. Leukemia 20, 2155–2161 (2006). https://doi.org/10.1038/sj.leu.2404420

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