Sebastian Giebel1, Myriam Labopin2, Michael Potter3, Xavier Poiré4, Henrik Sengeloev5, Gerard Socié6, Anne Huynh7, Boris V Afanasyev8, Urs Schanz9, Olle Ringden10, Peter Kalhs11, Dietrich W Beelen12, Antonio M Campos13, Tamás Masszi14, Jonathan Canaani15, Mohamad Mohty16, Arnon Nagler17. 1. Dept. of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland. Electronic address: sgiebel@io.gliwice.pl. 2. Acute Leukemia Working Party of the EBMT, Paris, France; Dept. of Hematology, Hôpital Saint-Antoine, Paris, France. 3. Leukemia Myeloma Units, The Royal Marsden Center, London, UK. 4. Dept. of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 5. Dept. of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 6. Dept. of Hematology - BMT, Hopital St. Louis, Paris, France. 7. Institut Universitaire Du Cancer, Oncopole IUCT, Toulouse, France. 8. R.M. Gorbacheva Memorial Institute of Children Oncology, Academician I.P. Pavlov First St. Petersburg State Medical University, Saint-Petersburg, Russia. 9. Clinic of Hematology, University Hospital Zurich, Zurich, Switzerland. 10. Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Stockholm, Sweden. 11. Dept. of Internal Medicine I, Bone Marrow Transplamntation, Medical University of Vienna, Vienna, Austria. 12. Dept. of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany. 13. BMT Unit, Instituto Português de Oncologia, Porto, Portugal. 14. 3rd Dept. of Internal Medicine Semmelweis University, St. István & St. Laszlo Hospital, Budapest, Hungary. 15. Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel. 16. Dept. of Hematology, Hôpital Saint-Antoine, Paris, France. 17. Acute Leukemia Working Party of the EBMT, Paris, France; Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel.
Abstract
BACKGROUND: Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs). METHODS: We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014. RESULTS: In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)-based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01). CONCLUSION: In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.
BACKGROUND: Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs). METHODS: We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014. RESULTS: In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)-based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01). CONCLUSION: In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.
Authors: Emma Lennmyr; Karin Karlsson; Lucia Ahlberg; Hege Garelius; Erik Hulegårdh; Antonio S Izarra; Joel Joelsson; Piotr Kozlowski; Andreea Moicean; Beata Tomaszewska-Toporska; Anna Lübking; Helene Hallböök Journal: Eur J Haematol Date: 2019-06-06 Impact factor: 2.997
Authors: M N Lyu; E L Jiang; Y He; D L Yang; Q L Ma; A M Pang; W H Zhai; J L Wei; Y Huang; G X Zhang; R L Zhang; S Z Feng; M Z Han Journal: Zhonghua Xue Ye Xue Za Zhi Date: 2020-05-14