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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
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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
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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
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Journal Article
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
2021
Overview
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.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Acute lymphoblastic leukemia
/ Adult
/ Adults
/ Antineoplastic Agents - therapeutic use
/ Cancer
/ Female
/ Hematopoietic Stem Cell Transplantation - methods
/ Humans
/ Leukemia
/ Male
/ Medicine
/ Oncology
/ Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy
/ Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality
/ Survival
/ Transplantation Conditioning - methods
/ Transplantation, Homologous - methods
/ Youth
