RE: "The Wasteland of Relapsed Adult ALL"

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).

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.

Usama Gergis, MD
Assistant Professor of Medicine
Leukemia service
Weill Cornell Medical College

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