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Biol Blood Marrow Transplant. 2017 Jul;23(7):1117-1121. doi: 10.1016/j.bbmt.2017.04.003. Epub 2017 Apr 7.

Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia.

Author information

1
Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio. Electronic address: hamiltb2@ccf.org.
2
Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
3
Division of Hematology/Medical Oncology, Northwestern University, Chicago, Illinois.
4
Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
5
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California.
6
Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
7
Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia.
8
Department of Medicine, Seidman Cancer Center, University Hospitals of Cleveland, Cleveland, Ohio.
9
Blood and Marrow Transplant Program, Ohio State University, Columbus, Ohio.
10
Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
11
Division of Hematologic Malignancies and Cellular Therapy, University of Kansas, Kansas City, Kansas.
12
Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee.
13
Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.
14
Bone Marrow Transplant and Leukemia Program, Washington University in St Louis, St Louis, Missouri.
15
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Weill Cornell Medical College, New York, New York.
16
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with T cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission (CR) and high-risk patients in first CR. Given its relative rarity, data on outcomes of HCT for T-ALL are limited. We conducted a multicenter retrospective cohort study using data from 208 adult patients who underwent HCT between 2000 and 2014 to describe outcomes of allogeneic HCT for T-ALL in the contemporary era. The median age at HCT was 37 years, and the majority of patients underwent HCT in CR, using total body irradiation (TBI)-based myeloablative conditioning regimens. One-quarter of the patients underwent alternative donor HCT using a mismatched, umbilical cord blood, or haploidentical donor. With a median follow up of 38 months, overall survival at 5 years was 34%. The corresponding cumulative incidence of non-relapse mortality and relapse was 26% and 41%, respectively. In multivariable analysis, factors significantly associated with overall survival were the use of TBI (HR, 0.57; P = .021), age >35 years (HR, 1.55; P = .025), and disease status at HCT (HR, 1.98; P = .005 for relapsed/refractory disease compared with CR). Relapse was the most common cause of death (58% of patients). Allogeneic HCT remains a potentially curative option in selected patients with adult T-ALL, although relapse is a major cause of treatment failure.

KEYWORDS:

Acute lymphoblastic leukemia; Allogeneic; Hematopoietic cell transplantation; Relapse-free survival; Survival; T cell

PMID:
28396160
PMCID:
PMC5549947
DOI:
10.1016/j.bbmt.2017.04.003
[Indexed for MEDLINE]
Free PMC Article

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