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
Wieduwilt, Matthew J. (University of California)
Stock, Wendy (University of Chicago Medicine)
Advani, Anjali (Cleveland Clinic)
Luger, Selina (University of Pennsylvania Medical Center)
Larson, Richard A. (University of Chicago Medicine)
Tallman, Martin (Memorial Sloan Kettering Cancer Center. Leukemia Service, Department of Medicine)
Appelbaum, Frederick (Fred Hutchinson Cancer Research Center)
Zhang, Mei-Jie (Medical College of Wisconsin. Division of Biostatistics)
Bo-Subait, Khalid (Medical College of Wisconsin)
Wang, Hai-Lin (Medical College of Wisconsin)
Bhatt, Vijaya Raj (University of Nebraska Medical Center)
Dholaria, Bhagirathbhai (Vanderbilt University Medical Center)
Eapen, Mary (Medical College of Wisconsin)
Hamadani, Mehdi (Medical College of Wisconsin)
Jamy, Omer (University of Alabama at Birmingham)
Prestidge, Tim (Starship Children's Hospital (Auckland, Nova Zelanda))
Pulsipher, Michael (Children's Hospital Los Angeles Cancer)
Ritchie, David (Peter MacCallum Cancer Centre)
Rizzieri, David (Duke University)
Sharma, Akshay (St. Jude Children's Research Hospital (Memphis, Estats Units d'Amèrica))
Barba, Pere (Hospital Universitari Vall d'Hebron)
Sandmaier, Brenda M. (Fred Hutchinson Cancer Research Center)
de Lima, Marcos (University Hospitals Case Medical Center)
Kebriaei, Partow (The University of Texas MD Anderson Cancer Center)
Litzow, Mark (Mayo Clinic.)
Saber, Wael (Medical College of Wisconsin)
Weisdorf, Daniel (University of Minnesota)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Acute lymphocytic leukaemia
Publicat a:	Leukemia, Vol. 35 (march 2021) , p. 2076-2085, ISSN 1476-5551

DOI: 10.1038/s41375-021-01213-5
PMID: 33785862

10 p, 1.3 MB

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