Outcomes and prognostic factors of adults with refractory or relapsed T-cell acute lymphoblastic leukemia included in measurable residual disease-oriented trials
| Autor: | Ribera J, Morgades M, Genesca E, Chapchap E, Montesinos P, Acuna-Cruz E, Gil C, Garcia-Cadenas I, Barba P, Gonzalez-Campos J, de Llano M, Torrent A, Granada I, Bernal T, Diaz-Beya M, Amigo M, Coll R, Tormo M, Vall-llovera F, Gomez-Centurion I, Sanchez-Sanchez M, Soria B, Cladera A, Artola M, Garcia-Guinon A, Gimenez-Conca A, Amador M, Martinez-Sanchez P, Algarra J, Vidal M, Alonso N, Maluquer C, Llorente L, Garcia-Boyero R, Ciudad J, Feliu E, Orfao A, PETHEMA Grp |
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| Přispěvatelé: | Fundación 'la Caixa', Instituto de Salud Carlos III, Generalitat de Catalunya |
| Rok vydání: | 2021 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty Neoplasm Residual Adolescent medicine.medical_treatment T cell Salvage therapy Disease Hematopoietic stem cell transplantation acute lymphoblastic leukemia Precursor T-Cell Lymphoblastic Leukemia-Lymphoma Young Adult Refractory T-cell Internal medicine medicine Humans business.industry Hazard ratio Hematology General Medicine Middle Aged Prognosis Confidence interval relapsed refractory medicine.anatomical_structure Treatment Outcome outcome Female Bone marrow business |
| Zdroj: | HEMATOLOGICAL ONCOLOGY r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante instname Digital.CSIC. Repositorio Institucional del CSIC r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA r-FISABIO. Repositorio Institucional de Producción Científica r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Hematological Oncology r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe |
| ISSN: | 0278-0232 1099-1069 |
| Popis: | 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. La Caixa" Foundation and ISCIII, Grant/ Award Number: PI19/01828; Generalitat de Catalunya (GRC), Grant/Award Number: 2017 SGR288 |
| Databáze: | OpenAIRE |
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