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Am J Hematol. 2017 Jan;92(1):42-49. doi: 10.1002/ajh.24575. Epub 2016 Nov 12.

Reduced intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia.

Author information

1
James Cancer Center, Ohio State University, Columbus, OH.
2
CIBMTR (Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
3
Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
4
Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
5
Emory University Hospital, Atlanta, GA.
6
Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, IL.
7
M.D. Anderson Cancer Center, Houston, TX.
8
The Ottawa Hospital Blood and Marrow Transplant Program and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
9
Indiana University Hospital/ Riley Hospital for Children, Indianapolis, IN.
10
Department of Blood and Marrow Transplantation, H. Lee Moffit Cancer Center and Research Institute, Tampa, FL.
11
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
12
Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
13
Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
14
University of Kansas, Westwood, KS.
15
Hopital Saint-Antoine, APHP, Universite Pierre & Marie Curie, INSERM UMRs U938, Paris, France.
16
St. Vincent's Hospital, Darlinghurst, NSW, Australia.
17
Barnes Jewish Hospital, St. Louis, MO.
18
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
19
Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden.
20
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
21
Divsion of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN.
22
Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN.
#
Contributed equally

Abstract

Older adults with B-cell acute lymphoblastic leukemia (B-ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B-ALL age 55 years and older and explored prognostic factors associated with long-term outcomes. Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55-72) with B-ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001 and 2012 using mostly unrelated donor (59%) or HLA-matched sibling (32%). Among patients with available cytogenetic data, the Philadelphia chromosome (Ph+) was present in 50%. The 3-year cumulative incidences of nonrelapse mortality (NRM) and relapse were 25% (95% confidence intervals (CI): 20-31%) and 47% (95% CI: 41-53%), respectively. Three-year overall survival (OS) was 38% (95% CI: 33-44%). Relapse remained the leading cause of death accounting for 49% of all deaths. In univariate analysis, 3 year risk of NRM was significantly higher with reduced Karnofsky performance status (KPS <90: 34% (95% CI: 25-43%) versus KPS ≥90 (18%; 95% CI: 12-24%, P = 0.006). Mortality was increased in older adults (66+ vs. 55-60: Relative Risk [RR] 1.51 95% CI: 1.00-2.29, P = 0.05) and those with advanced disease (RR 2.13; 95% CI: 1.36-3.34, P = 0.001). Survival of patients in CR1 yields 45% (95% CI: 38-52%) at 3 years and no relapse occurred after 2 years. We report promising OS and acceptable NRM using RIC HCT in older patients with B-ALL. Disease status in CR1 and good performance status are associated with improved outcomes. Am. J. Hematol. 92:42-49, 2017.

PMID:
27712033
PMCID:
PMC5167625
DOI:
10.1002/ajh.24575
[Indexed for MEDLINE]
Free PMC Article

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