Faculty Collaboration Database

Pretransplant Consolidation Is Not Beneficial for Adults with ALL Undergoing Myeloablative Allogeneic Transplantation. Biol Blood Marrow Transplant 2018 May;24(5):945-955

Date

12/25/2017

Pubmed ID

29275139

Pubmed Central ID

PMC5953798

DOI

10.1016/j.bbmt.2017.12.784

Scopus ID

2-s2.0-85044651033 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is curative for patients with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR1) with chemotherapy. However, the benefit of consolidation chemotherapy remains uncertain in patients undergoing alloHCT. We compared clinical outcomes of 524 adult patients with ALL in CR1 who received ≥2 (n = 109), 1 (n = 93), or 0 cycles (n = 322) of consolidation before myeloablative alloHCT from 2008 to 2012. As expected, time to alloHCT was longer with increasing cycles of consolidation. Patients receiving ≥2, 1, or 0 cycles of consolidation had an adjusted 3-year cumulative incidence of relapse of 20%, 27%, and 22%; 1-year transplant-related mortality (TRM) of 16%, 18%, and 23%; adjusted 3-year leukemia-free survival (LFS) of 54%, 48%, and 47%; and 3-year overall survival (OS) of 63%, 59%, and 54% (all P values >.40). Multivariable analysis confirmed that consolidation was not prognostic for LFS (relative risk, 1.20, 95% confidence interval, .86 to 1.67; P = .28 for no consolidation; RR, 1.18, 95% confidence interval, .79 to 1.76; P = .41 for 1 cycle versus ≥2 cycles = reference). Similarly, consolidation was not associated with OS, relapse, TRM, or graft-versus-host disease. We conclude that consolidation chemotherapy does not appear to provide added benefit in adult ALL patients with available donors who undergo myeloablative alloHCT in CR1.

Author List

Bejanyan N, Zhang MJ, Wang HL, Lazaryan A, de Lima M, Marks DI, Sandmaier BM, Bachanova V, Rowe J, Tallman M, Kebriaei P, Kharfan-Dabaja M, Peter Gale R, Lazarus HM, Ustun C, Copelan E, Ky Hamilton B, Schiller G, Hogan W, Hashmi S, Seftel M, Kanakry CG, Olsson RF, Martino R, Saber W, Khoury HJ, Weisdorf DJ

Authors

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

Adult
Aged
Consolidation Chemotherapy
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Middle Aged
Myeloablative Agonists
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Survival Analysis
Time Factors
Transplantation, Homologous
Treatment Outcome
Young Adult