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Clinical Trial
. 2017 Jan;52(1):20-27.
doi: 10.1038/bmt.2016.194. Epub 2016 Sep 12.

Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes

J E Brammer  1 , R M Saliba  1 , J L Jorgensen  2 , C Ledesma  1 , S Gaballa  1 , M Poon  3 , R T Maziarz  4 , R E Champlin  1 , C Hosing  1 , P Kebriaei  1
Affiliations
Clinical Trial

Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes

J E Brammer et al. Bone Marrow Transplant. 2017 Jan.

Abstract

This study aims to provide a detailed analysis of allogeneic stem cell transplantation (allo-SCT) outcomes in a large T-cell acute lymphoblastic leukemia (T-ALL) cohort with a specific emphasis on the effects of pre-transplant minimal residual disease (MRD) and disease subtype, including the aggressive early-thymic precursor (ETP) subtype. Data from 102 allo-SCT patients with a diagnosis of T-ALL from three centers were retrospectively analyzed. Patients were grouped into four T-ALL subtypes: ETP, early, cortical and mature. At 3 years, overall survival (OS), PFS, non-relapse mortality and cumulative incidence (CI) progression were 35, 33, 11 and 55%, respectively. Patients transplanted in first complete remission (CR1) had a 3-year OS of 62% versus those transplanted in CR2 or greater (24%) (hazards ratio 1.6, P=0.2). Patients with MRD positivity at the time of transplant had significantly higher rates of progression compared with those with MRD negativity (76 vs 34%, hazards ratio 2.8, P=0.006). There was no difference in OS, PFS or cumulative incidence (CI) progression between disease subtypes, including ETP (n=16). ETP patients transplanted in CR1 (n=10) had OS of 47%, comparable to other disease subtypes, suggesting that allo-SCT can overcome the poor prognosis associated with ETP. MRD status at transplant was highly predictive of disease relapse, suggesting novel therapies are necessary to improve transplant outcomes.

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Conflict of interest statement

Conflict of Interest:

The authors declare no conflict of interest with this report.

Figures

Figure 1:
Figure 1:
Overall Transplant Outcomes for Entire Cohort (n=102)
Figure 2A:
Figure 2A:
Overall Survival after Transplant According to T-ALL Subtype (n=102)
Figure 2B:
Figure 2B:
Overall Survival in ETP Patients Receiving Allogeneic Transplant in First Complete Remission
Figure 3:
Figure 3:
Cumulative Incidence Progression by MRD Status at Time of Transplant
See this image and copyright information in PMC

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