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Multicenter Study
. 2017 Jan;102(1):139-149.
doi: 10.3324/haematol.2016.145631. Epub 2016 Sep 29.

Improving results of allogeneic hematopoietic cell transplantation for adults with acute lymphoblastic leukemia in first complete remission: an analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Sebastian Giebel  1 , Myriam Labopin  2   3 , Gerard Socié  4 , Dietrich Beelen  5 , Paul Browne  6 , Liisa Volin  7 , Slawomira Kyrcz-Krzemien  8 , Ibrahim Yakoub-Agha  9 , Mahmoud Aljurf  10 , Depei Wu  11 , Mauricette Michallet  12 , Renate Arnold  13 , Mohamad Mohty  2 , Arnon Nagler  3   14
Affiliations
Multicenter Study

Improving results of allogeneic hematopoietic cell transplantation for adults with acute lymphoblastic leukemia in first complete remission: an analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Sebastian Giebel et al. Haematologica. 2017 Jan.

Abstract

Allogeneic hematopoietic cell transplantation is widely used to treat adults with high-risk acute lymphoblastic leukemia. The aim of this study was to analyze whether the results changed over time and to identify prognostic factors. Adult patients treated between 1993 and 2012 with myeloablative allogeneic hematopoietic cell transplantation from HLA matched sibling (n=2681) or unrelated (n=2178) donors in first complete remission were included. For transplantations from sibling donors performed between 2008 and 2012, 2-year probabilities of overall survival were: 76% (18-25 years old), 69% (26-35 and 36-45 years old) and 60% (46-55 years old). Among recipients of transplantations from unrelated donors, the respective survival rates were 66%, 70%, 61%, and 62%. In comparison with the 1993-2007 period, significant improvements were observed for all age groups except for the 26-35-year old patients. In a multivariate model, transplantations performed between 2008 and 2012, when compared to 1993-2007, were associated with significantly reduced risks of non-relapse mortality (Hazard Ratio 0.77, P=0.00006), relapse (Hazard Ratio 0.85, P=0.007), treatment failure (Hazard Ratio 0.81, P<0.00001), and overall mortality (Hazard Ratio 0.79, P<0.00001). In the analysis restricted to transplantations performed between 2008 and 2012, the use of total body irradiation-based conditioning was associated with reduced risk of relapse (Hazard Ratio 0.48, P=0.004) and treatment failure (Hazard Ratio 0.63, P=0.02). We conclude that results of allogeneic hematopoietic cell transplantation for adults with acute lymphoblastic leukemia improved significantly over time. Total body irradiation should be considered as the preferable type of myeloablative conditioning.

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Figures

Figure 1.
Figure 1.
Outcome of matched sibling donor – hematopoietic cell transplantation for adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1). Changes over time in the period 1993–2012. (A) Relapse incidence (RI), (B) non-relapse mortality (NRM), (C) leukemia-free survival (LFS), (D) overall survival (OS).
Figure 2.
Figure 2.
Outcome of unrelated donor – hematopoietic cell transplantation for adults with acute lymphoblastic leukemia (ALL) in first complete remission (CR1). Changes over time in the period 1993–2012. (A) Relapse incidence (RI), (B) non-relapse mortality (NRM), (C) leukemia-free survival (LFS), (D) overall survival (OS).
Figure 3.
Figure 3.
Outcome of allogeneic hematopoietic stem cell transplantation (alloHSCT) performed in the period 2008–2012 according to the type of conditioning (total body irradiation-based vs. chemotherapy-based). (A) Relapse incidence (RI), (B) non-relapse mortality (NRM), (C) leukemia-free survival (LFS), (D) overall survival (OS).
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References

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