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

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 recei...

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Detalles Bibliográficos
Autores: Wieduwilt, Matthew J.|||0000-0002-5414-9228, Stock, Wendy, Advani, Anjali|||0000-0003-0015-5902, Luger, Selina|||0000-0003-3364-4366, Larson, Richard A.|||0000-0001-9168-3203, Tallman, Martin, Appelbaum, Frederick, Zhang, Mei-Jie, Bo-Subait, Khalid, Wang, Hai-Lin, Bhatt, Vijaya Raj|||0000-0003-2513-0533, Dholaria, Bhagirathbhai|||0000-0003-2371-3655, Eapen, Mary, Hamadani, Mehdi|||0000-0001-5372-510X, Jamy, Omer|||0000-0003-2411-4742, Prestidge, Tim|||0000-0003-4078-5001, Pulsipher, Michael|||0000-0003-3030-8420, Ritchie, David, Rizzieri, David, Sharma, Akshay|||0000-0003-3281-2081, Barba, Pere|||0000-0001-7076-7969, Sandmaier, Brenda M.|||0000-0002-9767-9739, de Lima, Marcos|||0000-0002-8568-4522, Kebriaei, Partow|||0000-0002-8607-9404, Litzow, Mark|||0000-0002-9816-6302, Saber, Wael, Weisdorf, Daniel|||0000-0001-8078-8579
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:248844
Acceso en línea:https://ddd.uab.cat/record/248844
https://dx.doi.org/urn:doi:10.1038/s41375-021-01213-5
Access Level:acceso abierto
Palabra clave:Acute lymphocytic leukaemia
Descripción
Sumario: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.

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