To the Editor:
I have a few reservations with regard to Dr. Jerald Radich’s article “The Wasteland of Relapsed Adult ALL” (March/April 2008 issue).
-Usama Gergis, MD, Assistant Professor of Medicine, Leukemia service, at Weill Cornell Medical College
References
1.
The article incorrectly quoted the recently published paper
by Goldstone, et al. In the original paper, autologous transplant has
the least overall survival, not chemotherapy, as per Dr. Radich’s
article.
2.
One has to be careful interpreting the results of
the MRC UKALL XII/ECOG E2993 as the paper did not include a
multi-variant analysis for the high-risk group not benefiting from
allogeneic bone marrow transplant. The high-risk group included
patients who are older than 35 years, have leukocytosis (more than 100
k/L for B lineage and 30 k/L for T lineage), or are
Philadelphia-chromosome-positive. The surprisingly high NRM, rather
than RRM, hints at older age in the high-risk group rather than
leukocytosis or Ph+ as the real reason behind these dismal findings.