Intensive Therapy before or during the Conditioning Regimen of Allogeneic Marrow Transplantation in Adult Acute Lymphoblastic Leukemia Patients: We Must Choose to Reduce Toxicity-A Groupe Ouest-Est d'Etude des Leucémies et Autres Maladies du Sang Study

To improve the results in the treatment of adult acute lymphoblastic leukemia patients, different strategies have been proposed. The intensification could concern the induction and early consolidation phases, the conditioning regimen before allogeneic bone marrow transplantation (alloBMT), or both. We analyzed 2 consecutive trials for adult patients in first remission and with the same prognostic features. The Leucémie Aiguë Lymphoblastique Paris-Ouest-France (LALPOF) protocol proposed alloBMT with standard conditioning after a classic induction and intensified consolidation scheme; the Groupe Ouest Est des Leucemies Aiguës Lymphoblastiques (GOLEAL1) protocol tested an intensified induction and consolidation course before alloBMT with a reinforced conditioning regimen. The 4-year survival rates after alloBMT for LALPOF and GOELAL1 were, respectively, 71% ± 12% and 36% ± 13% (P = .009). The 4-year disease-free survival reached 75% ± 11% in the LALPOF study and 69% ± 13% in the GOELAL1 study (P = .30). The toxic death rate was significantly lower in the LALPOF (2/18) than in the GOELAL1 (6/15) group. Event-free survival at 4 years was significantly higher in LALPOF than in GOELAL1: 66% ± 11% and 35% ± 11%, respectively (P = .02). For adult acute lymphoblastic leukemia patients in first remission, the intensification of chemotherapy before a reinforced conditioning regimen before alloBMT may lead to an increased toxic death rate.