Yusuke Isshiki1,2, Chikako Ohwada2, Emiko Sakaida2, Masahiro Onoda1, Nobuyuki Aotsuka3, Hiroaki Tanaka4, Motoharu Fukazawa5, Ryuko Cho6, Takeaki Sugawara7, Takeharu Kawaguchi8, Satoru Hara9, Akira Yokota1. 1. Department of Hematology, Chiba Aoba Municipal Hospital. 2. Department of Hematology, Chiba University Hospital. 3. Department of Hematology and Oncology, Japanese Red Cross Narita Hospital. 4. Department of Hematology, Asahi General Hospital. 5. Department of Internal Medicine, JCHO Funabashi Central Hospital. 6. Department of Hematology, Chibaken Saiseikai Narashino Hospital. 7. Department of Hematology and Oncology, Chiba Cancer Center. 8. Department of Hematology, Oami Municipal Hospital. 9. Department of Hematology, Chiba Rosai Hospital, Japan.
Abstract
BACKGROUND: The efficacy of conventional chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been controversial as post-remission therapies for adult Philadelphia chromosome-negative acute lymphoblastic leukemia patients. METHODS: We retrospectively analyzed 96 adolescent and adult cases of Philadelphia chromosome-negative acute lymphoblastic leukemia to evaluate whether allo-HSCT should be performed after first complete remission (1CR). RESULTS: In total, 34 patients received chemotherapy followed by allo-HSCT (HSCT group) and 62 received chemotherapy alone (chemotherapy group). No significant differences in the event-free survival (EFS) or overall survival were observed between the two groups. In the chemotherapy group, use of pediatric regimens was significantly associated with favorable EFS, while high white blood cell (WBC) count and CD20 positivity were associated with poor outcome. In patients who received pediatric regimens, subsequent allo-HSCT did not influence EFS. In patients who received conventional chemotherapy (adult regimen), subsequent allo-HSCT did not improve EFS. High WBC count and CD20 positivity were also significantly associated with poor EFS in patients who received adult regimens. Patients with low WBC count and absence of CD20 who received adult regimens did not benefit from allo-HSCT. CONCLUSIONS: Allo-HSCT may not be required in the pediatric regimen-eligible patients; however, pediatric regimen-ineligible patients with either CD20 positivity or high WBC count should receive allo-HSCT after achieving 1CR. This study was registered at http://www.umin.ac.jp/ctr/ as #C000016287.
BACKGROUND: The efficacy of conventional chemotherapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been controversial as post-remission therapies for adult Philadelphia chromosome-negative acute lymphoblastic leukemia patients. METHODS: We retrospectively analyzed 96 adolescent and adult cases of Philadelphia chromosome-negative acute lymphoblastic leukemia to evaluate whether allo-HSCT should be performed after first complete remission (1CR). RESULTS: In total, 34 patients received chemotherapy followed by allo-HSCT (HSCT group) and 62 received chemotherapy alone (chemotherapy group). No significant differences in the event-free survival (EFS) or overall survival were observed between the two groups. In the chemotherapy group, use of pediatric regimens was significantly associated with favorable EFS, while high white blood cell (WBC) count and CD20 positivity were associated with poor outcome. In patients who received pediatric regimens, subsequent allo-HSCT did not influence EFS. In patients who received conventional chemotherapy (adult regimen), subsequent allo-HSCT did not improve EFS. High WBC count and CD20 positivity were also significantly associated with poor EFS in patients who received adult regimens. Patients with low WBC count and absence of CD20 who received adult regimens did not benefit from allo-HSCT. CONCLUSIONS: Allo-HSCT may not be required in the pediatric regimen-eligible patients; however, pediatric regimen-ineligible patients with either CD20 positivity or high WBC count should receive allo-HSCT after achieving 1CR. This study was registered at http://www.umin.ac.jp/ctr/ as #C000016287.
Authors: David I Marks; Amy A Kirkwood; Clare J Rowntree; Melanie Aguiar; Katharine E Bailey; Brendan Beaton; Paul Cahalin; Anna Z Castleton; Laura Clifton-Hadley; Mhairi Copland; Anthony H Goldstone; Richard Kelly; Emma Lawrie; SooWah Lee; Andrew K McMillan; Mary Frances McMullin; Tobias F Menne; Rachel J Mitchell; Anthony V Moorman; Bela Patel; Pip Patrick; Paul Smith; David Taussig; Deborah Yallop; Krisztina Zuborne Alapi; Adele K Fielding Journal: Lancet Haematol Date: 2022-04 Impact factor: 18.959