Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR. Leukemia 2021 Jul;35(7):2076-2085
Date
04/01/2021Pubmed ID
33785862Pubmed Central ID
PMC8257494DOI
10.1038/s41375-021-01213-5Scopus ID
2-s2.0-85103388621 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
Optimal post-remission therapy for adolescents and young adults (AYAs) with Ph-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1) is not established. We compared overall survival (OS), disease-free survival (DFS), relapse, and non-relapse mortality (NRM) for patients receiving post-remission therapy on CALGB 10403 to a cohort undergoing myeloablative (MA) allogeneic hematopoietic cell transplantation (HCT) in CR1. In univariate analysis, OS was superior with chemotherapy compared to MA allogeneic HCT (3-year OS 77% vs. 53%, P < 0.001). In multivariate analysis, allogeneic HCT showed inferior OS (HR 2.00, 95% CI 1.5-2.66, P < 0.001), inferior DFS (HR 1.62, 95% CI 1.25-2.12, P < 0.001), and increased NRM (HR 5.41, 95% CI 3.23-9.06, P < 0.001) compared to chemotherapy. A higher 5-year relapse incidence was seen with chemotherapy compared to allogeneic HCT (34% vs. 23%, P = 0.011). Obesity was independently associated with inferior OS (HR 2.17, 95% CI 1.63-2.89, P < 0.001), inferior DFS (HR 1.97, 95% CI 1.51-2.57, P < 0.001), increased relapse (1.84, 95% CI 1.31-2.59, P < 0.001), and increased NRM (HR 2.10, 95% CI 1.37-3.23, P < 0.001). For AYA ALL patients in CR1, post-remission therapy with pediatric-style chemotherapy is superior to MA allogeneic HCT for OS, DFS, and NRM.
Author List
Wieduwilt MJ, Stock W, Advani A, Luger S, Larson RA, Tallman M, Appelbaum F, Zhang MJ, Bo-Subait K, Wang HL, Bhatt VR, Dholaria B, Eapen M, Hamadani M, Jamy O, Prestidge T, Pulsipher M, Ritchie D, Rizzieri D, Sharma A, Barba P, Sandmaier BM, de Lima M, Kebriaei P, Litzow M, Saber W, Weisdorf DAuthors
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinMehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentAdult
Antineoplastic Agents
Cohort Studies
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation
Humans
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Remission Induction
Transplantation Conditioning
Transplantation, Homologous
Young Adult