Outcomes and prognostic factors of adults with refractory or relapsed T-cell acute lymphoblastic leukemia included in measurable residual disease-oriented trials.

Autor: Ribera JM; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Morgades M; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Genescà E; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Chapchap EC; Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil., Montesinos P; Hematology Department, Hospital Universitari i Politènic La Fe, Valencia, Spain., Acuña-Cruz E; Hematology Department, Hospital Universitari i Politènic La Fe, Valencia, Spain., Gil C; Hematology Department, Hospital General de Alicante, Alicante, Spain., García-Cadenas I; Hematology Department, Hospital de Sant Pau, Barcelona, Spain., Barba P; Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain., González-Campos J; Hematology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Queipo de Llano MP; Hematology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain., Torrent A; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Ribera J; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Granada I; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Bernal T; Hematology Department, Hospital Central de Asturias, ISPA, IUOPA, Oviedo, Spain., Díaz-Beyá M; Hematology Department, Hospital Clínic, Barcelona, Spain., Amigo ML; Hematology Department, Hospital Morales Meseguer, Murcia, Spain., Coll R; Hematology Department, Institut Català d'Oncologia, Hospital Josep Trueta, Girona, Spain., Tormo M; Hematology and Oncology Department, Instituto de investigación INCLIVA, Hospital Clínico Universitario, Valencia, Spain., Vall-Llovera F; Hematology Department, Hospital Universitari Mútua de Terrasa, Terrassa, Spain., Gómez-Centurión I; Hematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Sánchez-Sánchez MJ; Hematology Department, Hospital Universitario Lucus Augusti, Lugo, Spain., Soria B; Hematology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain., Cladera A; Hematology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain., Artola MT; Hematology Department, Hospital Universitario de Donostia, Donostia, Spain., Garcia-Guiñon A; Hematology Department, Hospital Arnau de Vilanova, Lleida, Spain., Giménez-Conca A; Hematology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina., Amador ML; Hematology Department, Complejo Hospitalario de Pontevedra, Spain., Martínez-Sánchez P; Hematology Department, Hospital 12 de Octubre, Madrid, Spain., Algarra JL; Hematology Department, Hospital General Universitario Albacete, Albacete, Spain., Vidal MJ; Hematology Department, Hospital Universitario de León, León, Spain., Alonso N; Hematology Department, Hospital Universitario Santiago de Compostela, Santiago, Spain., Maluquer C; Hematology Department, Institut Catala d'Oncologia-Hospital Duran y Reynals, L'Hospitalet de Llobregat, Barcelona, Spain., Llorente L; Hematology Department, Hospital HM Sanchinarro, Madrid, Spain., García-Boyero R; Hematology Department, Hospital General Universitario de Castellón, Castellón, Spain., Ciudad J; Hematology Department, Centro de Investigación del Cáncer, IBSAL, IBMCC, CIBERONC, Hospital Universitario, Universidad de Salamanca-CSIC, Salamanca, Spain., Feliu E; Hematology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Orfao A; Hematology Department, Centro de Investigación del Cáncer, IBSAL, IBMCC, CIBERONC, Hospital Universitario, Universidad de Salamanca-CSIC, Salamanca, Spain.
Jazyk: angličtina
Zdroj: Hematological oncology [Hematol Oncol] 2021 Oct; Vol. 39 (4), pp. 529-538. Date of Electronic Publication: 2021 Aug 18.
DOI: 10.1002/hon.2910
Abstrakt: Despite high complete remission (CR) rates with frontline therapy, relapses are frequent in adults with T-cell acute lymphoblastic leukemia (T-ALL) with limited salvage options. We analyzed the outcomes and prognostic factors for CR to salvage therapy and overall survival (OS) of patients with R/R T-ALL included in two prospective measurable residual disease-oriented trials. Seventy-five patients (70 relapsed, 5 refractory) were identified. Relapses occurred in bone marrow, isolated or combined in 50 patients, and in the central nervous system (CNS; isolated or combined) in 20. Second CR was attained in 30/75 patients (40%). Treatment with FLAG-Ida and isolated CNS relapse were independently associated with a higher CR rate after first salvage therapy. The median OS was 6.2 (95% confidence interval [CI], 3.9-8.6) months, with a 4-year OS probability of 18% (95% CI, 9%-27%). No differences in survival were observed according to the treatment with hematopoietic stem cell transplantation in patients in CR after first salvage therapy. Multivariable analysis showed a ≥12-month interval between first CR and relapse, CR after first salvage therapy and isolated CNS relapse as favorable prognostic factors for OS with hazard ratios (HR) (95% CI) of 1.931 (1.109-3.362), 2.958 (1.640-5.334), and 2.976 (1.157-7.655), respectively. This study confirms the poor outcomes of adults with R/R T-ALL among whom FLAG-Ida was the best of the rescue therapies evaluated. Late relapse, CR after first rescue therapy and isolated CNS relapse showed prognostic impact on survival. More effective rescue therapies are needed in adults with R/R T-ALL.
(© 2021 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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