The t(9;22) occurs in 20-30% of patients with adult ALL. Although the remission rate is approximately 60-80% with intensive induction therapy, Ph+ ALL is not considered curable with standard chemotherapy, with long-term survival rates of less than 10%.29'95 To improve outcome in Ph+ ALL, efforts have focused on dose intensification with allo SCT in first remission, which is currently the recommended treatment. In a preliminary report from the MRC UKALL X11/ECOG E2993 study, the EFS was 38% at 3 years for 35 patients with Ph+ ALL who received postremission allo SCT in CR1, compared to only 5% for those who received postremission chemotherapy or auto SCT in CR1.96 Although difficult to compare because of variability in patient characteristics and treatment regimen, other small series report survival rates between 30 and 60%,97-102 and all share the conclusions that Ph+ ALL patients appear to do best when an allo SCT is performed in first remission. For Ph+ ALL patients without HLA-matched sibling donors, the efficacy of matched unrelated donor (MUD) transplants has also been evaluated. In one small series of 18 young patients (median age was only 25 years) with Ph+ ALL

Adult mature B-cell ALL studies3


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