Allogeneic SCT in refractory or relapsed adult ALL is effective without prior reinduction chemotherapy

Bone Marrow Transplantation
T H TerweyR Arnold

Abstract

We present 60 patients with refractory (n=8) or relapsed (n=52) adult ALL who received allogeneic hematopoietic SCT (HSCT) with (n=41) or without (n=19) prior reinduction chemotherapy. In our center, omission of reinduction is recommended if a suitable donor is promptly available, tumor burden is moderate and disease features suggest a highly aggressive course. Overall survival (OS) of the whole cohort at 1, 2 and 5 years was 42, 33 and 28%, respectively. Leukemia-free survival at 1, 2 and 5 years was 37, 33 and 24%. Deaths were due to relapse (n=25), acute or chronic GVHD (n=7), infections (n=8) or toxicity (n=4). Interestingly, patients who did not receive reinduction before HSCT had better outcomes than patients who received reinduction with OS at 1, 2 and 5 years being 58 vs 34%, 47 vs 25% and 47 vs 18%, respectively (P=0.039). Importantly, even achievement of a second CR after reinduction was not associated with improved survival compared to patients directly proceeding to HSCT. We conclude that patients who undergo HSCT for refractory or relapsed ALL can achieve long-term survival. In selected patients, reinduction chemotherapy can be omitted if immediate HSCT is feasible.

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Citations

Apr 29, 2010·Current Hematologic Malignancy Reports·Theis H TerweyRenate Arnold
Aug 23, 2011·Leukemia & Lymphoma·Satoshi Nishiwaki, Koichi Miyamura
Oct 15, 2009·Hematology/oncology Clinics of North America·Farhad Ravandi, Partow Kebriaei
Aug 2, 2011·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Denise M OlianskyTheresa Hahn
Oct 14, 2009·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Qi-Fa LiuHuo Tan
Aug 3, 2016·The Journal of Clinical Investigation·Partow KebriaeiLaurence J N Cooper
Jan 17, 2017·Annals of Hematology·Shin Hye YooUNKNOWN Korean Society of Blood and Marrow Transplantation
Jan 22, 2020·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Takayoshi TachibanaUNKNOWN Kanto Study Group for Cell Therapy (KSGCT)

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