Can high-dose therapy and sibling HSCT overcome the adverse risk posed by presence of the Ph chromosome?
There are a number of studies of myeloablative therapy followed by sib allo HSCT that specifically relate to Ph-pos ALL.10, 13, 14, 15, 16 The main features of these studies are listed in Table 2. In summary, the data indicate that in selected individuals, disease-free survival (DFS) or OS appears better than would be expected with treatment with chemotherapy alone. The strongest support for this contention from published data comes from Dombret et al., where the existence of an allogeneic donor among those eligible for HSCT was independently predictive of remission duration. The largest prospective study of patients with Ph-pos ALL has been carried out by the in a UK–USA collaboration, UKALLXII/ECOG2993. The trial examined the role of HSCT in Ph-pos ALL by assigning all patients, wherever possible, to allo HSCT using etoposide and 13.2 Gy TBI as conditioning—in the absence of a sibling donor, a MUD was selected. The data have only been published in abstract form17 but support the assi
