The current national acute lymphoblastic leukaemia (ALL) trial in adults investigated whether a low (reduced) intensity chemotherapy regimen prior to transplant could improve the outcome of patients with ALL who are over 40 years of age. The results (60% 2 year survival) are very encouraging but patients who come to transplant with small amounts of ‘residual’ disease had less good outcomes. The goal of this trial is to see if a slightly stronger chemotherapy regimen (involving total body irradiation, (TBI)) can improve results by reducing the chance of the disease coming back (relapsing) without increasing the chance of not surviving the transplant. Up to 242 patients will be ‘randomised’ to the trial to receive either the established chemotherapy of fludarabine and melphalan or cyclophosphamide and TBI to compare the outcomes between the two treatment regimens. Other measures to reduce relapse will be the earlier use of donor white cell infusions and earlier stopping of immune suppressive drugs to enhance the immune effect of the transplanted cells (graft). Patients will be followed up for a minimum of 3 years. All patients on the next national ALL trial (UKALL XV) will be offered this trial but it will also be open to patients not on this study.

• Inclusion Criteria :
  • Patients between the ages of 40-70 years. NB: Patients under the age of 40 who are considered unsuitable for a myeloablative transplant may enrol onto the trial following discussion with the CI via the Trials Office
  • Patients with ALL in first or second CR
  • Availability of a human leukocyte antigen (HLA) identical sibling or suitable matched donor (suitable matched defined as no greater than a single allele mismatch at HLA A, B, C or DRβ1). A single allele mismatch is permitted if there are adverse cytogenetics or MRD positivity at any timepoint
  • Patients considered suitable to undergo a RIC allogeneic SCT as clinically judged by the Local Investigator including:- - Adequate hepatic and renal function as determined by full blood count and biochemistry assessment - Resolution of any toxic effects of prior therapy (including radiotherapy, chemotherapy or surgical procedures). Patients with bone marrow suppression following therapy may enter the trial - Patients with abnormal cardiac and/or pulmonary function must be considered fit for allogeneic SCT including 8Gy of TBI at the time of randomisation.
  • Patients with an ECOG performance status 0,1 or 2
  • Females of and male patients of reproductive potential (i.e., not post-menopausal or surgically sterilised) must use appropriate, highly effective, contraception from the point of admission for transplant conditioning therapy until 12 months after transplant (see section 8.1.2.2)
  • Patients have given written informed consent
  • Patients willing and able to comply with scheduled study visits and laboratory tests
• Exclusion Criteria :
  • Patients with contraindications to receiving RIC allogeneic SCT
  • Female patients who are pregnant or breastfeeding. All women of childbearing potential (WOCBP) must have a negative pregnancy test before commencing treatment
  • Adults of reproductive potential not willing to use appropriate, effective, contraception during the specified period
  • Patients with renal or hepatic impairment as clinically judged by Local Investigator
  • Patients with active infection, HIV-positive or chronic active Hep-A or -C
  • Patients with concurrent active malignancy. Patients with a previous history of malignancy can be included if that malignancy is considered to be at a low risk of recurrence
  • Previous exposure to a high dose of radiotherapy
• Study end date : 22/11/2027
• Wales-Based Study Contact : emma.kempshall@wales.nhs.uk

Contact details

 emma.kempshall@wales.nhs.uk