Allogeneic hematopoietic cell transplantation for primary refractory acute lymphoblastic leukemia: A report from the Acute Leukemia Working Party of the EBMT

Autor: Pavlu, J, Labopin, M, Zoellner, AK, Sakellari, I, Stelljes, M, Finke, J, Fanin, R, Stuhler, G, Afanasyev, BV, Bloor, AJ, Anagnostopoulos, A, Mohty, M, Giebel, S, Nagler, A
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Adult
Male
Cancer Research
Transplantation Conditioning
Adolescent
IMPACT
Antineoplastic Agents
T-CELL
RELAPSE
stem cell transplantation
Disease-Free Survival
conditioning regimen
Young Adult
acute lymphoblastic leukemia (ALL)
TOTAL-BODY IRRADIATION
BONE-MARROW TRANSPLANTS
Humans
Transplantation
Homologous
Treatment Failure
Oncology & Carcinogenesis
Aged
Retrospective Studies
Science & Technology
CONDITIONING REGIMENS
ACUTE MYELOBLASTIC-LEUKEMIA
Remission Induction
Hematopoietic Stem Cell Transplantation
allogeneic transplantation
refractory disease
total body irradiation
Oncology
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
PRIMARY INDUCTION FAILURE
Prognosis
Survival Rate
Female
Life Sciences & Biomedicine
1112 Oncology And Carcinogenesis
Whole-Body Irradiation
Follow-Up Studies
Popis: BACKGROUND: Patients with primary refractory acute lymphoblastic leukemia (PREF ALL) who fail to achieve a complete remission (CR) after 2 courses of chemotherapy have a dismal prognosis without undergoing allogeneic hematopoietic cell transplantation (HCT). To the authors’ knowledge, there currently are no data regarding factors influencing transplantation outcomes. METHODS: The authors retrospectively studied outcomes of transplantation for cases of PREF ALL reported to European Society for Blood and Marrow Transplantation registry. Eligibility criteria for the current analysis included adult patients who underwent their first HCT for PREF ALL between 2000 and 2012. PREF disease was defined as the failure to achieve a morphological CR after 2 courses of induction chemotherapy. RESULTS: Data regarding 86 adult patients were analyzed. With a median follow-up of 106 months, the probability of survival was 36% at 2 years and 23% at 5 years. The probability of leukemia-free survival was 28% and 17%, respectively, and the probability of nonrecurrence mortality was 20% and 29%, respectively, at 2 years and 5 years. For 66 patients who achieved a CR (77%), the survival at 2 years and 5 years was 36% and 29%, respectively. In multivariate analysis, use of total body irradiation was found to be associated with improved survival. Total body irradiation and infusion of female hematopoietic cells into male recipients was associated with improved leukemia-free survival. These findings were incorporated into a scoring system that identified 3 groups (those with 2, 1, or no prognostic factors) with survival rates of 57%, 22%, and 8%, respectively. CONCLUSIONS: Although overall these patients would clearly benefit from the introduction of novel antileukemic therapies, the data from the current study support the use of allogeneic HCT in selected patients with PREF ALL.
Databáze: OpenAIRE
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