Abstract
The execution of a prospective trial involving the random assignment of adult patients with acute lymphoblastic leukemia (ALL) in first remission who have a human leukocyte antigen (HLA) -matched related donor into 1 of the 2 groups, those undergoing hematopoietic stem cell transplantation (HSCT) or those treated with chemotherapy alone, is difficult in terms of practicality. Therefore, we performed a decision analysis to establish the optimal post-remission treatment in such patients. Transition probabilities after continuing chemotherapy in the first remission period, and after treatment with HSCT in patients with various disease statuses, were established according to the results of Japan Adult Leukemia Study Group (JALSG) prospective studies, and data from the Transplant Registry Unified Management Program (TRUMP) of Japan Society for Hematopoietic cell transplantation (JSHCT), respectively. As a result, the decision to perform HSCT in the first remission period, as opposed to continuing treatment with chemotherapy in this period, is recommended for adult patients with ALL who have an HLA-matched related donor. In addition, we were able to demonstrate efficacy when combining the large amount of clinical data regarding chemotherapy and HSCT. Further improvement in two large nationwide data obtained from results of JALSG studies regarding chemotherapy and from TRUMP of JSHCT regarding HSCT is anticipated, and the direct association between these 2 large data will generate important results with respect to treatment strategies for hematological diseases in Japan.
