**5. Conclusion**

*Acute Leukemias*

benefit of ASCT for ALL in all risk groups [42].

**number**

*Summaries of studies on autologous stem cell transplantation in ALL.*

**Reference Patient** 

Goldstone et al. 2008 [34]

Thomas et al. 2004 (LALA94 study) [35]

Hunault et al. 2003 (GOELAMS) [36]

Fiere et al. 1993 [37]

Powles et al. 2002 [38]

Several studies have been published about the experience of ASCT in ALL. The results of some recent trials are summarized in **Table 2**. Data from three prospective trials of the French group have failed to demonstrate any significant superiority of ASCT over chemotherapy, even in a subset of high-risk patients [39–41]. Conversely, it has been reported that ASCT may be an effective treatment for ALL patients who experienced an isolated extramedullary relapse. A recent randomized study of 433 adult standard risk ALL patients showed that LFS at 5 years was significantly better in patients who underwent allo-HSCT compared with ASCT (60% vs. 42%, *P* = 0.01). In a large study which is comparing chemotherapy and autologous transplantation in ALL patients, the LFS and OS were found superior for chemotherapy group [34]. In the LALA-87 trial, results in standard-risk ALL were similar for Allo-SCT [37] and for chemotherapy or ASCT and then the same group reported no

The Philadelphia chromosome (Ph) translocation (9; 22) is the most common chromosomal abnormality seen in adult patients with ALL. The t(9;22) is observed

**Period Age** 

1929 1993–2006 15–59 Ph- ALL

922 1994–2002 15–55 ASCT vs.

198 1994–1998 15–59 Allo-SCT vs.

572 1986–1991 15–60 ASCT vs.

77 1984–1998 16–59 All patients

**(years)**

**Study design Outcomes**

5-year OS is better in donor group, 53% versus 45% (P = .01), and lower the relapse rate in donor group (P < or = .001) OS is better in Chemotherapy group than ASCT group (46% [95% CI = 39–53%] vs. 37% [95% CI = 31–44%]; *P* = .03)

ASCT did not show superiority over chemotherapy in high-risk ALL patients.

OS and LFS is better in Allo-SCT (75% vs. 39% *P* = .0027 and 72% vs. 32% *P* = .0004 respectively) relapse rates higher in ASCT

Not significantly benefit of ASCT over chemotherapy

10-year LFS and OS rates are 50% (95% CI, 38–62%) and 53% (95% CI, 41–65%), respectively

patients divided groups; with donor vs. no donor chemotherapy vs. ASCT group

chemotherapy

ASCT

consolidative chemotherapy

> underwent ASCT

**214**

**Table 2.**

According to NCCN guidelines; Patients with good-risk AML are recommended to undergo high-dose cytarabine-based chemotherapy. Patients with poor-risk AML are recommended to undergo allogeneic stem cell transplantation (alloSCT). However, the best post remission therapy for patients with intermediate-risk AML in first complete remission (AML/CR1) is still uncertain. ASCT would be an option in CR1 and MRD negative. ASCT is a kind of standard treatment of CR2 in APL patients. There is no benefit of ASCT in Ph negative ALL patients however ASCT is a therapeutic option for relapsed Ph + ALL. Although the main disadvantages of ASCT are the possibility of contamination of leukemic cells in the stem cell product and the absence of graft-versus-leukemia effect, which lead to a higher relapse rates than that of Allo-SCT, ASCT should be considered a standard therapy in acute leukemia patients who are not eligible Allo-SCT and MRD negative in CR1 and the patients without poor risk.
