TY - JOUR
T1 - Pretransplant Consolidation Is Not Beneficial for Adults with ALL Undergoing Myeloablative Allogeneic Transplantation
AU - Bejanyan, Nelli
AU - Zhang, Mei Jie
AU - Wang, Hai Lin
AU - Lazaryan, Aleksandr
AU - de Lima, Marcos
AU - Marks, David I.
AU - Sandmaier, Brenda M.
AU - Bachanova, Veronika
AU - Rowe, Jacob
AU - Tallman, Martin
AU - Kebriaei, Partow
AU - Kharfan-Dabaja, Mohamed
AU - Peter Gale, Robert
AU - Lazarus, Hillard M.
AU - Ustun, Celalettin
AU - Copelan, Edward
AU - Ky Hamilton, Betty
AU - Schiller, Gary
AU - Hogan, William
AU - Hashmi, Shahrukh
AU - Seftel, Matthew
AU - Kanakry, Christopher G.
AU - Olsson, Richard F.
AU - Martino, Rodrigo
AU - Saber, Wael
AU - Khoury, H. Jean
AU - Weisdorf, Daniel J.
N1 - Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2018/5
Y1 - 2018/5
N2 - Allogeneic hematopoietic cell transplantation (alloHCT) is curative for patients with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR1) with chemotherapy. However, the benefit of consolidation chemotherapy remains uncertain in patients undergoing alloHCT. We compared clinical outcomes of 524 adult patients with ALL in CR1 who received ≥2 (n = 109), 1 (n = 93), or 0 cycles (n = 322) of consolidation before myeloablative alloHCT from 2008 to 2012. As expected, time to alloHCT was longer with increasing cycles of consolidation. Patients receiving ≥2, 1, or 0 cycles of consolidation had an adjusted 3-year cumulative incidence of relapse of 20%, 27%, and 22%; 1-year transplant-related mortality (TRM) of 16%, 18%, and 23%; adjusted 3-year leukemia-free survival (LFS) of 54%, 48%, and 47%; and 3-year overall survival (OS) of 63%, 59%, and 54% (all P values >.40). Multivariable analysis confirmed that consolidation was not prognostic for LFS (relative risk, 1.20, 95% confidence interval,.86 to 1.67; P =.28 for no consolidation; RR, 1.18, 95% confidence interval,.79 to 1.76; P =.41 for 1 cycle versus ≥2 cycles = reference). Similarly, consolidation was not associated with OS, relapse, TRM, or graft-versus-host disease. We conclude that consolidation chemotherapy does not appear to provide added benefit in adult ALL patients with available donors who undergo myeloablative alloHCT in CR1.
AB - Allogeneic hematopoietic cell transplantation (alloHCT) is curative for patients with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR1) with chemotherapy. However, the benefit of consolidation chemotherapy remains uncertain in patients undergoing alloHCT. We compared clinical outcomes of 524 adult patients with ALL in CR1 who received ≥2 (n = 109), 1 (n = 93), or 0 cycles (n = 322) of consolidation before myeloablative alloHCT from 2008 to 2012. As expected, time to alloHCT was longer with increasing cycles of consolidation. Patients receiving ≥2, 1, or 0 cycles of consolidation had an adjusted 3-year cumulative incidence of relapse of 20%, 27%, and 22%; 1-year transplant-related mortality (TRM) of 16%, 18%, and 23%; adjusted 3-year leukemia-free survival (LFS) of 54%, 48%, and 47%; and 3-year overall survival (OS) of 63%, 59%, and 54% (all P values >.40). Multivariable analysis confirmed that consolidation was not prognostic for LFS (relative risk, 1.20, 95% confidence interval,.86 to 1.67; P =.28 for no consolidation; RR, 1.18, 95% confidence interval,.79 to 1.76; P =.41 for 1 cycle versus ≥2 cycles = reference). Similarly, consolidation was not associated with OS, relapse, TRM, or graft-versus-host disease. We conclude that consolidation chemotherapy does not appear to provide added benefit in adult ALL patients with available donors who undergo myeloablative alloHCT in CR1.
KW - ALL
KW - Allogeneic transplant
KW - Consolidation chemotherapy
KW - Myeloablative conditioning
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UR - http://www.scopus.com/inward/citedby.url?scp=85044651033&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2017.12.784
DO - 10.1016/j.bbmt.2017.12.784
M3 - Article
C2 - 29275139
AN - SCOPUS:85044651033
SN - 1083-8791
VL - 24
SP - 945
EP - 955
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -