Pediatric-inspired therapy compared to allografting for Philadelphia chromosome-negative adult ALL in first complete remission

for the Acute Leukemia Committee of the CIBMTR and the Dana Farber ALL Consortium

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

For adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) in first complete remission (CR1), allogeneic hematopoietic cell transplantation (HCT) is an established curative strategy. However, pediatric-inspired chemotherapy may also offer durable leukemia-free survival in the absence of HCT. We compared 422 HCT recipients aged 18-50 years with Ph-ALL in CR1 reported to the CIBMTR with an age-matched concurrent cohort of 108 Ph- ALL CR1 patients who received a Dana-Farber Consortium pediatric-inspired non-HCT regimen. At 4 years of follow-up, incidence of relapse after HCT was 24% (95% CI 19-28) versus 23% (95% CI 15-32) for the non-HCT (chemo) cohort (P=0.97). Treatment-related mortality (TRM) was higher in the HCT cohort [HCT 37% (95% CI 31-42) versus chemo 6% (95% CI 3-12), P<0.0001]. DFS in the HCT cohort was 40% (95% CI 35-45) versus 71% (95% CI 60-79) for chemo, P<0.0001. Similarly, OS favored chemo [HCT 45% (95% CI 40-50)] versus chemo 73% [(95% CI 63-81), P<0.0001]. In multivariable analysis, the sole factor predictive of shorter OS was the administration of HCT [hazard ratio 3.12 (1.99-4.90), P<0.0001]. For younger adults with Ph- ALL, pediatric-inspired chemotherapy had lower TRM, no increase in relapse, and superior overall survival compared to HCT.

Original languageEnglish (US)
Pages (from-to)322-329
Number of pages8
JournalAmerican Journal of Hematology
Volume91
Issue number3
DOIs
StatePublished - Mar 1 2016

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Philadelphia Chromosome
Cell Transplantation
Homologous Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pediatrics
Therapeutics
Recurrence
Drug Therapy
Survival
Mortality
Young Adult
Leukemia

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

for the Acute Leukemia Committee of the CIBMTR and the Dana Farber ALL Consortium. / Pediatric-inspired therapy compared to allografting for Philadelphia chromosome-negative adult ALL in first complete remission. In: American Journal of Hematology. 2016 ; Vol. 91, No. 3. pp. 322-329.
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abstract = "For adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) in first complete remission (CR1), allogeneic hematopoietic cell transplantation (HCT) is an established curative strategy. However, pediatric-inspired chemotherapy may also offer durable leukemia-free survival in the absence of HCT. We compared 422 HCT recipients aged 18-50 years with Ph-ALL in CR1 reported to the CIBMTR with an age-matched concurrent cohort of 108 Ph- ALL CR1 patients who received a Dana-Farber Consortium pediatric-inspired non-HCT regimen. At 4 years of follow-up, incidence of relapse after HCT was 24{\%} (95{\%} CI 19-28) versus 23{\%} (95{\%} CI 15-32) for the non-HCT (chemo) cohort (P=0.97). Treatment-related mortality (TRM) was higher in the HCT cohort [HCT 37{\%} (95{\%} CI 31-42) versus chemo 6{\%} (95{\%} CI 3-12), P<0.0001]. DFS in the HCT cohort was 40{\%} (95{\%} CI 35-45) versus 71{\%} (95{\%} CI 60-79) for chemo, P<0.0001. Similarly, OS favored chemo [HCT 45{\%} (95{\%} CI 40-50)] versus chemo 73{\%} [(95{\%} CI 63-81), P<0.0001]. In multivariable analysis, the sole factor predictive of shorter OS was the administration of HCT [hazard ratio 3.12 (1.99-4.90), P<0.0001]. For younger adults with Ph- ALL, pediatric-inspired chemotherapy had lower TRM, no increase in relapse, and superior overall survival compared to HCT.",
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Pediatric-inspired therapy compared to allografting for Philadelphia chromosome-negative adult ALL in first complete remission. / for the Acute Leukemia Committee of the CIBMTR and the Dana Farber ALL Consortium.

In: American Journal of Hematology, Vol. 91, No. 3, 01.03.2016, p. 322-329.

Research output: Contribution to journalArticle

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T1 - Pediatric-inspired therapy compared to allografting for Philadelphia chromosome-negative adult ALL in first complete remission

AU - for the Acute Leukemia Committee of the CIBMTR and the Dana Farber ALL Consortium

AU - Seftel, Matthew D.

AU - Neuberg, Donna

AU - Zhang, Mei Jie

AU - Wang, Hai Lin

AU - Ballen, Karen Kuhn

AU - Bergeron, Julie

AU - Couban, Stephen

AU - Freytes, César O.

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AU - Kharfan-Dabaja, Mohamed A.

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AU - Weisdorf, Daniel J.

AU - Akpek, Gorgun

AU - Bacher, Ulrike

AU - Bachanova, Veronika

AU - Baron, Frederic

AU - Bashey, Asad

AU - Cahn, Jean Yves

AU - Camitta, Bruce M.

AU - Copelan, Edward A.

AU - Lima, Marcos De

AU - Deol, Abhinav

AU - Gale, Robert Peter

AU - Gergis, Usama

AU - Hogan, William J.

AU - Kebriaei, Partow

AU - Litzow, Mark R.

AU - Loren, Alison W.

AU - Miller, Alan M.

AU - Norkin, Maxim

AU - Olsson, Richard F.

AU - Reshef, Ran

AU - Sabloff, Mitchell

AU - Sandmaier, Brenda M.

AU - Savani, Bipin N.

AU - Schouten, Harry C.

AU - Vij, Ravi

AU - Wiernik, Peter H.

AU - Wirk, Baldeep

AU - Wood, William Allen1

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N2 - For adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) in first complete remission (CR1), allogeneic hematopoietic cell transplantation (HCT) is an established curative strategy. However, pediatric-inspired chemotherapy may also offer durable leukemia-free survival in the absence of HCT. We compared 422 HCT recipients aged 18-50 years with Ph-ALL in CR1 reported to the CIBMTR with an age-matched concurrent cohort of 108 Ph- ALL CR1 patients who received a Dana-Farber Consortium pediatric-inspired non-HCT regimen. At 4 years of follow-up, incidence of relapse after HCT was 24% (95% CI 19-28) versus 23% (95% CI 15-32) for the non-HCT (chemo) cohort (P=0.97). Treatment-related mortality (TRM) was higher in the HCT cohort [HCT 37% (95% CI 31-42) versus chemo 6% (95% CI 3-12), P<0.0001]. DFS in the HCT cohort was 40% (95% CI 35-45) versus 71% (95% CI 60-79) for chemo, P<0.0001. Similarly, OS favored chemo [HCT 45% (95% CI 40-50)] versus chemo 73% [(95% CI 63-81), P<0.0001]. In multivariable analysis, the sole factor predictive of shorter OS was the administration of HCT [hazard ratio 3.12 (1.99-4.90), P<0.0001]. For younger adults with Ph- ALL, pediatric-inspired chemotherapy had lower TRM, no increase in relapse, and superior overall survival compared to HCT.

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