Pretransplant Consolidation Is Not Beneficial for Adults with ALL Undergoing Myeloablative Allogeneic Transplantation

Nelli Bejanyan, Mei Jie Zhang, Hai Lin Wang, Aleksandr Lazaryan, Marcos de Lima, David I. Marks, Brenda M. Sandmaier, Veronika Bachanova, Jacob Rowe, Martin Tallman, Partow Kebriaei, Mohamed Kharfan-Dabaja, Robert Peter Gale, Hillard M. Lazarus, Celalettin Ustun, Edward Copelan, Betty Ky Hamilton, Gary Schiller, William Hogan, Shahrukh HashmiMatthew Seftel, Christopher G. Kanakry, Richard F. Olsson, Rodrigo Martino, Wael Saber, H. Jean Khoury, Daniel J. Weisdorf

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)945-955
Number of pages11
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number5
DOIs
StatePublished - May 2018

Keywords

  • ALL
  • Allogeneic transplant
  • Consolidation chemotherapy
  • Myeloablative conditioning

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Bejanyan, N., Zhang, M. J., Wang, H. L., Lazaryan, A., de Lima, M., Marks, D. I., Sandmaier, B. M., Bachanova, V., Rowe, J., Tallman, M., Kebriaei, P., Kharfan-Dabaja, M., Peter Gale, R., Lazarus, H. M., Ustun, C., Copelan, E., Ky Hamilton, B., Schiller, G., Hogan, W., ... Weisdorf, D. J. (2018). Pretransplant Consolidation Is Not Beneficial for Adults with ALL Undergoing Myeloablative Allogeneic Transplantation. Biology of Blood and Marrow Transplantation, 24(5), 945-955. https://doi.org/10.1016/j.bbmt.2017.12.784