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. 2025 Sep;60(9):1228-1235.
doi: 10.1038/s41409-025-02632-z. Epub 2025 Jun 2.

Outcomes of allogeneic stem cell transplant in adult Philadelphia negative acute lymphoblastic leukemia patients treated with the pediatric-inspired GIMEMA 1913 protocol. A Campus ALL study

Gianluca Cavallaro  1 , Davide Lazzarotto  2 , Chiara Pavoni  1 , Francesca Valsecchi  1 , Anna Grassi  1 , Cristina Papayannidis  3 , Marco Cerrano  4 , Nicola Fracchiolla  5 , Fabio Giglio  6 , Michelina Dargenio  7 , Monia Lunghi  8 , Silvia Imbergamo  9 , Maria Ilaria Del Principe  10 , Silvia Trappolini  11 , Monica Fumagalli  12 , Patrizia Zappasodi  13 , Prassede Salutari  14 , Mario Delia  15 , Crescenza Pasciolla  16 , Federico Mosna  17 , Barbara Scappini  18 , Fabio Forghieri  19 , Patrizia Chiusolo  20 , Cristina Skert  21 , Benedetta Cambò  22 , Marzia Defina  23 , Giuseppe Lanzarone  24 , Endri Mauro  25 , Massimiliano Bonifacio  26 , Carla Mazzone  27 , Lidia Santoro  28 , Antonino Mulè  29 , Valentina Mancini  30 , Paola Minetto  31 , Giorgia Battipaglia  32 , Alessandro Cignetti  33 , Lara Aprile  34 , Sabina Chiaretti  35 , Robin Foà  35 , Anna Candoni  2   19 , Federico Lussana  36   37
Affiliations

Outcomes of allogeneic stem cell transplant in adult Philadelphia negative acute lymphoblastic leukemia patients treated with the pediatric-inspired GIMEMA 1913 protocol. A Campus ALL study

Gianluca Cavallaro et al. Bone Marrow Transplant. 2025 Sep.

Abstract

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is the best consolidative treatment for high-risk acute lymphoblastic leukemia (ALL). The Campus ALL study group analyzed the clinical outcomes of patients treated in the real-life with the pediatric-inspired and minimal/measurable residual disease (MRD)-oriented GIMEMA LAL1913 protocol who underwent alloHSCT. Key factors impacting on outcomes were MRD and remission status (1st complete remission vs 2nd complete remission) at transplant. MRD positivity was associated with poorer outcomes, with 3-year overall survival (OS) and disease-free survival (DFS) of 47% and 41% in MRD-positive patients compared to 80% and 70% in MRD-negative patients. Additionally, MRD negativity was associated with improved outcomes also for patients in 2nd complete remission with 3-year OS and DFS rates of 60% and 56%, respectively, compared to only 13% for both outcomes in MRD-positive cases. Patients older than 55 years showed survival rates comparable to younger patients, despite having a slightly higher non-relapse mortality, which remained below 20% at 3 years. These findings underscore the crucial role of alloHSCT in high-risk ALL and emphasize the importance of an early accurate disease risk allocation. The adverse outcome observed with MRD positivity advocates for early pre-transplant intervention with immunotherapy, whenever possible.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Outcomes based on remission status.
a Overall Survival (OS) in patients in first complete remission (CR1) vs second complete remission (CR2). b Disease-free survival (DFS) in patients in CR1 vs CR2. c Cumulative Incidence of Relapse (CIR) in patients in CR1 vs CR2.
Fig. 2
Fig. 2. Outcomes based on MRD response.
a Overall Survival (OS) in measurable residual disease (MRD)-negative vs MRD-positive patients. b Disease-free survival (DFS) in MRD-negative vs MRD-positive patients. c Cumulative Incidence of Relapse (CIR) in MRD-negative vs MRD-positive patients.
Fig. 3
Fig. 3. Outcomes based on MRD and remission status at the time of transplantation.
a Overall Survival (OS) according to measurable residual disease (MRD) and complete remission (CR) status. b Disease-free survival (DFS) according to MRD and CR status. c Cumulative Incidence of Relapse (CIR) according to MRD and CR status.
Fig. 4
Fig. 4. Outcomes based on the age at transplantation.
a Overall Survival (OS) in patients aged ≥55 vs <55 years. b Disease-free survival (DFS) in patients aged ≥55 vs <55 years. c Non-relapse mortality (NRM) in patients aged ≥55 vs <55 years.
Fig. 5
Fig. 5
Multivariable analysis for overall survival (OS) and disease-free survival (DFS).
See this image and copyright information in PMC

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