***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Recombinant human granulocyte colony-stimulating factor ( G-CSF ; filgrastim ) shortens the time to neutrophil recovery after intensive chemotherapy , but its role in the treatment of adults with acute lymphoblastic leukemia ( ALL ) is uncertain . We r and omly assigned 198 adults with untreated ALL ( median age , 35 years ; range , 16 to 83 ) to receive either placebo or G-CSF ( 5 microgram/kg/d ) subcutaneously , beginning 4 days after starting intensive remission induction chemotherapy and continuing until the neutrophil count was > /=1 , 000/microL for 2 days . The study assignment was unblinded as individual patients achieved a complete remission ( CR ) . Patients initially assigned to G-CSF then continued to receive G-CSF through 2 monthly courses of consolidation therapy . Patients assigned to placebo received no further study drug . The median time to recover neutrophils > /=1,000/microL during the remission induction course was 16 days ( interquartile range [ IQR ] , 15 to 18 days ) for the patients assigned to receive G-CSF and 22 days ( IQR , 19 to 29 days ) for the patients assigned to placebo ( P < .001 ) . Patients in the G-CSF group had significantly shorter duration s of neutropenia ( < 1 , 000/microL ) and thrombocytopenia ( < 50,000/microL ) and fewer days in the hospital ( median , 22 days v 28 days ; P = .02 ) compared with patients receiving placebo . The patients assigned to receive G-CSF had a higher CR rate and fewer deaths during remission induction than did those receiving placebo ( P = .04 by the chi-square test for trend ) . During Courses IIA and IIB of consolidation treatment , patients in the G-CSF group had significantly more rapid recovery of neutrophils > /=1,000/microL than did the control group by approximately 6 to 9 days . However , the patients in the G-CSF group did not complete the planned first 3 months of chemotherapy any more rapidly than did the patients in the placebo group . Overall toxicity was not lessened by the use of G-CSF . After a median follow-up of 4 . 7 years , there were no significant differences in either the disease-free survival ( P = .53 ) or the overall survival ( P = .25 ) for the patients assigned to G-CSF ( medians , 2.3 years and 2.4 years , respectively ) compared with those assigned to placebo ( medians , 1.7 and 1.8 years , respectively ) . Adults who received intensive chemotherapy for ALL benefited from G-CSF treatment , but its use did not markedly affect the ultimate outcome Abstract Objective To examine the extent and nature of outcome reporting bias in a broad cohort of published r and omised trials . Design Retrospective review of publications and follow up survey of authors . Cohort All journal articles of r and omised trials indexed in PubMed whose primary publication appeared in December 2000 . Main outcome measures Prevalence of incompletely reported outcomes per trial ; reasons for not reporting outcomes ; association between completeness of reporting and statistical significance . Results 519 trials with 553 publications and 10 557 outcomes were identified . Survey responders ( response rate 69 % ) provided information on unreported outcomes but were often unreliable — for 32 % of those who denied the existence of such outcomes there was evidence to the contrary in their publications . On average , over 20 % of the outcomes measured in a parallel group trial were incompletely reported . Within a trial , such outcomes had a higher odds of being statistically non-significant compared with fully reported outcomes ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.7 ) for efficacy outcomes ; 1.9 ( 1.1 to 3.5 ) for harm outcomes ) . The most commonly reported reasons for omitting efficacy outcomes included space constraints , lack of clinical importance , and lack of statistical significance . Conclusions Incomplete reporting of outcomes within published articles of r and omised trials is common and is associated with statistical non- significance . The medical literature therefore represents a selective and biased subset of study outcomes , and trial protocol s should be made publicly available While commonly accepted in poor-risk acute lymphoblastic leukemia ( ALL ) , the role of allogeneic hematopoietic stem cell transplantation ( allo-SCT ) is still disputed in adult patients with st and ard-risk ALL . We evaluated outcome of patients with ALL in first complete remission ( CR1 ) , according to a sibling donor versus no-donor comparison . Eligible patients ( 433 ) were entered in 2 consecutive , prospect i ve studies , of whom 288 ( 67 % ) were younger than 55 years , in CR1 , and eligible to receive consolidation by either an autologous SCT or an allo-SCT . Allo-SCT was performed in 91 of 96 patients with a compatible sibling donor . Cumulative incidences of relapse at 5 years were , respectively , 24 and 55 % for patients with a donor versus those without a donor ( hazard ratio [ HR ] , 0.37 ; 0.23 - 0.60 ; P < .001 ) . Nonrelapse mortality estimated 16 % ( + /- 4 ) at 5 years after allo-SCT . As a result , disease-free survival ( DFS ) at 5 years was significantly better in the donor group : 60 versus 42 % in the no-donor group ( HR : 0.60 ; 0.41 - 0.89 ; P = .01 ) . After risk-group analysis , improved outcome was more pronounced in st and ard-risk patients with a donor , who experienced an overall survival of 69 % at 5 years ( P = .05 ) . In conclusion , st and ard-risk ALL patients with a sibling donor may show favorable survival following SCT , due to both a strong reduction of relapse and a modest nonrelapse mortality . This trial is registered with http://www.trialregister.nl under trial ID NTR228 The GIMEMA ALL 0288 trial was design ed to evaluate the impact of a 7-day prednisone ( PDN ) pretreatment on complete remission ( CR ) achievement and length , the influence of the addition of cyclophosphamide ( r and om I ) to a conventional 4-drug induction on CR rate and duration , and whether an early post-CR intensification ( r and om II ) by an 8-drug consolidation could improve CR duration . Median follow-up of this study was 7.3 years . From January 1988 to April 1994 , among 794 adult ( > 12 but < 60 years ) patients registered , 778 were eligible . Their median age was 27.5 years ; 73 % had B-lineage acute lymphoblastic leukemia ( ALL ) and 22 % had T-lineage disease ; 18 % showed associated myeloid markers ; 47 of 216 analyzed patients ( 22 % ) had Philadelphia chromosome-positive ALL . Response to PDN pretreatment was observed in 65 % of cases . CR was achieved in 627 patients ( 82 % ) . Resistant patients and induction death rates were 11 % and 7 % , respectively . R and om II was applied to 388 patients with CR ; 201 had maintenance alone and 187 had consolidation followed by maintenance . The relapse rate was 60 % ; isolated central nervous system relapses were 8 % of all CRs and 13 % of all relapses . Median survival ( overall survival [ OS ] ) , continuous complete remission ( CCR ) , and disease-free survival ( DFS ) were 2.2 , 2.4 , and 2 years , respectively . PDN pretreatment response result ed the main independent factor influencing CR achievement , OS , CCR , and DFS ; the addition of cyclophosphamide in induction significantly influenced CR achievement in a multivariate analysis . Neither induction intensification nor early consolidation appeared to influence CCR and DFS duration . For the first time PDN pretreatment response proved to be a powerful factor predicting disease outcome in adult ALL patients PURPOSE Optimal postremission therapy remains controversial in adult patients with acute lymphoblastic leukemia ( ALL ) . In a large multicentric trial ( LALA87 ) , we compared allogeneic bone marrow transplantation ( BMT ) with other postremission therapies ( chemotherapy or autologous transplantation ) using the result of the human leukocyte antigen ( HLA ) typing as a r and om allocation . PATIENTS AND METHODS Patient eligibility requirements were as follows : ( 1 ) inclusion in LALA87 trial , ( 2 ) complete response to induction or salvage therapy , ( 3 ) age 15 to 40 years , and ( 4 ) at least one potential sibling donor . Patients with an HLA-identical sibling were assigned to the BMT group , while patients without a sibling donor constituted the control group . Allogeneic transplantation was scheduled for patients in the BMT group ; in the control group , patients were r and omly allocated to receive chemotherapy or autologous transplantation . RESULTS Of 284 eligible points , 257 entered the study : 116 were allocated to the BMT group and 141 to the control group . The 5-year survival rates were not statistically significantly different between the two groups . When only patients with high-risk ALL were considered ( those with [ 1 ] Philadelphia chromosome [ Ph1 ] ALL , [ 2 ] null or undifferentiated ALL , or [ 3 ] c-ALL with either age greater than 35 years or WBC count > 30 x 10(9)/L or time to achieve complete remission > 4 weeks ) , overall survival ( P = .03 ) and disease-free-survival ( P = .01 ) were better for the BMT group compared with the control group ( 5-year overall survival rates , 44 % v 20 % ; 5-year disease-free survival rates , 39 % v 14 % ) . CONCLUSION Allogeneic transplantation does not improve survival in patients with st and ard-risk ALL and should be recommended only for patients with adverse prognostic factors A prospect i ve , r and omized trial was initiated in adult acute lymphoblastic leukemia ( ALL ) to compare ( 1 ) disease-free survival ( DFS ) after allogeneic or autologous bone marrow transplantation ( BMT ) and ( 2 ) the relapse rate of patients treated with or without interleukin-2 ( IL-2 ) after autologous BMT .  A total of 135 previously untreated patients , aged under 55 years , received the Berlin-Frankfurt-Muster ( BFM ) induction regimen : 126 patients ( 93 % ) , of which 120 were HLA-typed , achieved complete remission ( CR ) . According to this genetic r and omization , patients with ( n = 43 ) or without an HLA-identical sibling ( n = 77 ) were to receive allogeneic or autologous BMT , respectively . The 3-year post-CR probability of DFS was significantly higher in the HLA-identical sibling group than in the non-HLA-identical sibling group ( 68 % v 26 % ; P < .001 ) . Eligible patients were r and omized to receive ( n = 30 ) or not to receive ( n = 30 ) IL-2 after autologous BMT : the 3-year post-BMT probability of continuous CR was similar in both groups ( 29 % v 27 % , respectively ) . We conclude that , in ALL , early allogeneic BMT after the BFM induction regimen is an effective consolidation treatment and that IL-2 does not decrease the high relapse rate observed after autologous BMT Adult patients with acute lymphoblastic leukemia ( ALL ) were treated according to the ALL90 study , the second prospect i ve study for ALL of the Japan Adult Leukemia Study Group ( JALSG ) . Its characteristics included response-oriented individualized induction therapy with six drugs ( doxorubicin , mitoxantrone , vincristine , prednisolone , [ corrected ] cyclophosphamide and L-asparaginase ) , and a prospect i ve comparison between allogeneic bone marrow transplantation ( allo-BMT ) and chemotherapy alone in patients below 45 years of age . The protocol consisted of one or two courses of induction , four courses of consolidation , and three courses of intensification including 12 month maintenance and six times of central nervous system ( CNS ) prophylaxis . Of 180 evaluable patients ( median age , 43 ) , 125 ( 69 % ) achieved complete remission ( CR ) . Predicted overall survival ( OAS ) , event-free survival and disease-free survival ( DFS ) were 15 , 10 and 14 % , respectively at the median follow-up period of 62 months . No specific toxicities were observed . Leukocytes < 30,000/microliter , normal karyotype , and blasts < 10 % in bone marrow at day 15 of induction therapy were significantly favorable prognostic factors for the achievement of CR , DFS and OAS by univariate analysis . Multivariate analysis showed leukocytes < 30,000/microliter and blasts < 10 % on day 15 was a significant factor for the achievement of CR , DFS and OAS . Ph-chromosome was found in 28 % ( 36/130 ) of patients examined and was one of the worst prognostic factors . All Ph positive patients were predicted to die within 600 days . Allo-BMT was not significantly superior to chemotherapy with respect to DFS ( P = 0.226 
    Output:
    
The results of this systematic review and meta- analysis support matched sibling donor allogeneic hematopoietic cell transplantation as the optimal post-remission therapy in ALL patients aged 15 years or over .
This therapy offers superior overall survival and disease-free survival , and significantly reduces the risk of disease relapse , but does impose an increased risk of non-relapse mortality .