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Observational Study
. 2024 Feb;204(2):628-637.
doi: 10.1111/bjh.19223. Epub 2023 Dec 5.

PASS-ALL study of paediatric-inspired versus adult chemotherapy regimens on survival of high-risk Philadelphia-negative B-cell acute lymphoblastic leukaemia with allogeneic haematopoietic stem cell transplantation

Zhixiang Wang  1   2   3 , Zhiping Fan  1   2 , Zhengwei Wu  1   4 , Li Xuan  1   2 , Xin Li  5 , Bingqing Tang  1 , Yiqian Liu  1 , Jiabao He  1   2 , Kangyu Huang  1 , Xuan Zhou  1   2 , Ya Gao  1 , Qiang Wang  1   2 , Xiaofang Li  1   2 , Ren Lin  1   2 , Na Xu  1   2 , Feng Huang  1   2 , Shunqing Wang  6 , Xingquan Liang  7 , Jingdong Zhang  3 , Xiaoli Liu  1   2 , Jing Sun  1   2 , Qifa Liu  1   2 , Hongsheng Zhou  1   2   3
Affiliations
Observational Study

PASS-ALL study of paediatric-inspired versus adult chemotherapy regimens on survival of high-risk Philadelphia-negative B-cell acute lymphoblastic leukaemia with allogeneic haematopoietic stem cell transplantation

Zhixiang Wang et al. Br J Haematol. 2024 Feb.

Abstract

This PASS-ALL study was designed to explore the effect of paediatric-inspired versus adult chemotherapy regimens on survival of adolescents and young adults (AYA) with high-risk Philadelphia chromosome-negative B-cell acute lymphoblastic leukaemia (HR PH-ve B-cell ALL) eligible for allogeneic haematopoietic stem cell transplantation (allo-HSCT). The PASS-ALL study is a multicentre, observational cohort study, and 143 patients with HR B-cell PH-ve ALL were enrolled from five centres-77 patients allocated in the paediatric-inspired cohort and 66 in the adult cohort with comparable baseline characteristics. Of the 143 patients, 128 cases underwent allo-HSCT. Three-year leukaemia-free survival (LFS) in the paediatric-inspired cohort was 72.2% (95% CI 60.8%-83.6%) compared with 44.6% (95% CI 31.9%-57.3%; p = 0.001). Furthermore, time-to-positive minimal residual disease (TTP-MRD) post-HSCT was marked different, 3-year cumulative incidence of relapse was 25.9% (95% CI 15.8%-37.2%) in paediatric cohort and 45.4% (95% CI 40.0%-57.9%) in adult cohort (p = 0.026). Finally, the 3-year OS rate was 75.3% (95% CI 64.9%-85.7%) for the paediatric-inspired cohort and 64.1% (95% CI 51.8%-76.4%) for the adult cohort (p = 0.074). On a multivariate analysis, paediatric-inspired regimen is a predictive factor for LFS (HR = 2.540, 95% CI 1.327-4.862, p = 0.005). Collectively, our data suggest that paediatric-inspired chemotherapy pre-HSCT results in deeper and durable MRD response reduces relapse post-HSCT and improves survival in HR B-cell PH-ve ALL patients with allo-HSCT.

Keywords: B-cell acute lymphoblastic leukaemia; Philadelphia chromosome-negative; allogeneic haematopoietic stem cell transplantation; high risk; paediatric-inspired regimen.

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References

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