Abdul Hamid Bazarbachi1, Myriam Labopin2, Nicolaus Kröger3, Arne Brecht4, Didier Blaise5, Johannes Clausen6, Renato Fanin7, Herman Einsele8, Luigi Cavanna9, Maija Itäla-Remes10, Claude Eric Bulabois11, Lukas Kündgen12, Hans Martin13, Christof Schmid14, Eva Maria Wagner-Drouet15, Nael Alakel16, Ali Bazarbachi17, Bipin Savani18, Arnon Nagler19, Mohamad Mohty20. 1. Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France; Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY. 2. Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France. 3. Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. German Clinic for Diagnistics, KMT Zentrum, Wiesbaden, Germany. 5. Departement D'Hematologie, Programme de Transplantation et de Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France. 6. Department of Internal Medicine I, Ordensklinikum Linz -Elisabethinen, Linz, Austria. 7. Clinica Ematologica, Azienda sanitaria Universitaria Integrata, DAMe, Università di Udine, Udine, Italy. 8. Department of Internal Medicine II, University Hospital Würzburg, Germany. 9. Departments of Oncology-Hematology, Ospedale "G. da Saliceto", Piacenza, Italy. Electronic address: l.cavanna@ausl.pc.it. 10. Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland. 11. Hematology Department, Grenoble Alpes University Hospital, Grenoble, France. 12. Department of Hematology and Oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany. 13. Department of Medicine II, Goethe University, Frankfurt, Germany. 14. Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany. 15. 3rd Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany. 16. Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. 17. Department of Internal Medicine, American University of Beirut, Beirut, Lebanon. 18. Vanderbilt University Medical Center, Nashville, TN. 19. Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel. 20. Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France. Electronic address: mohamad.mohty@inserm.fr.
Abstract
INTRODUCTION/ BACKGROUND: The treatment of acute lymphoblastic leukemia (ALL) in patients older than 70 is extremely challenging with dismal outcome. Allogeneic stem cell transplantation (alloHCT) has seen many advancements in the last decades showing benefits in younger ALL patients, but this treatment modality is decreasingly used with increasing age due to high treatment-related mortality. PATIENTS AND METHODS: We identified 84 ALL patients 70 to 84 years old allografted In 2002 to 2019 from a matched related (23%), unrelated (58%), haploidentical (17%), or cord blood (2%) donor at EBMT participating centers with a median follow-up of 23 months. RESULTS: The 2-year relapse incidence (RI) and non-relapse mortality were 37% and 28%, respectively, and 2-year leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were 35%, 39% and 23%, respectively. The strongest predictor of outcome was disease status at transplant whereby patients in first complete remission (CR1) had >50% 2-year OS, reflected in multivariate analysis (MVA) with significant improvement in RI, LFS, and GRFS (HR 0.23, 0.49, and 0.54, respectively). Furthermore, karnofsky score ≥90 reflective of good functional status positively influenced non-relapse mortality in both univariate and MVA (HR 0.37), and interestingly, donor CMV positivity appeared to negatively affect RI, LFS and OS in univariate analysis and RI in MVA (HR 2.87). CONCLUSION: Our data suggest that alloHCT is an option for elderly ALL patients, particularly those carefully selected and transplanted in CR1 especially if failed or without access to novel non-chemotherapy-based approaches.
INTRODUCTION/ BACKGROUND: The treatment of acute lymphoblastic leukemia (ALL) in patients older than 70 is extremely challenging with dismal outcome. Allogeneic stem cell transplantation (alloHCT) has seen many advancements in the last decades showing benefits in younger ALL patients, but this treatment modality is decreasingly used with increasing age due to high treatment-related mortality. PATIENTS AND METHODS: We identified 84 ALL patients 70 to 84 years old allografted In 2002 to 2019 from a matched related (23%), unrelated (58%), haploidentical (17%), or cord blood (2%) donor at EBMT participating centers with a median follow-up of 23 months. RESULTS: The 2-year relapse incidence (RI) and non-relapse mortality were 37% and 28%, respectively, and 2-year leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were 35%, 39% and 23%, respectively. The strongest predictor of outcome was disease status at transplant whereby patients in first complete remission (CR1) had >50% 2-year OS, reflected in multivariate analysis (MVA) with significant improvement in RI, LFS, and GRFS (HR 0.23, 0.49, and 0.54, respectively). Furthermore, karnofsky score ≥90 reflective of good functional status positively influenced non-relapse mortality in both univariate and MVA (HR 0.37), and interestingly, donor CMV positivity appeared to negatively affect RI, LFS and OS in univariate analysis and RI in MVA (HR 2.87). CONCLUSION: Our data suggest that alloHCT is an option for elderly ALL patients, particularly those carefully selected and transplanted in CR1 especially if failed or without access to novel non-chemotherapy-based approaches.
Authors: Kevin D Hofer; Urs Schanz; Rahel Schwotzer; Gayathri Nair; Markus G Manz; Corinne C Widmer Journal: Ann Hematol Date: 2022-02-19 Impact factor: 3.673