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.
Matthew J WieduwiltWendy StockAnjali S AdvaniSelina M LugerRichard A LarsonMartin TallmanFrederick AppelbaumMei-Jie ZhangKhalid Bo-SubaitHai-Lin WangVijaya Raj BhattBhagirathbhai R DholariaMary EapenMehdi HamadaniOmer JamyTim PrestidgeMichael A PulsipherDavid RitchieDavid RizzieriAkshay SharmaPere BarbaBrenda M SandmaierMarcos J deLimaPartow KebriaeiMark R LitzowWael SaberDaniel J WeisdorfPublished in: Leukemia (2021)
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.
Keyphrases
- stem cell transplantation
- free survival
- acute lymphoblastic leukemia
- bone marrow
- high dose
- locally advanced
- hematopoietic stem cell
- disease activity
- allogeneic hematopoietic stem cell transplantation
- ulcerative colitis
- physical activity
- end stage renal disease
- cell cycle arrest
- metabolic syndrome
- ejection fraction
- squamous cell carcinoma
- insulin resistance
- newly diagnosed
- type diabetes
- chronic kidney disease
- young adults
- weight loss
- radiation therapy
- stem cells
- risk factors
- mesenchymal stem cells
- cell proliferation
- body mass index
- prognostic factors
- weight gain
- high fat diet induced