Reduced intensity conditioned allograft yields favorable survival for older adults with B‐cell acute lymphoblastic leukemia
Abstract
Older adults with B‐cell acute lymphoblastic leukemia (B‐ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B‐ALL age 55 years and older and explored prognostic factors associated with long‐term outcomes. Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55–72) with B‐ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001 and 2012 using mostly unrelated donor (59%) or HLA‐matched sibling (32%). Among patients with available cytogenetic data, the Philadelphia chromosome (Ph+) was present in 50%. The 3‐year cumulative incidences of nonrelapse mortality (NRM) and relapse were 25% (95% confidence intervals (CI): 20–31%) and 47% (95% CI: 41–53%), respectively. Three‐year overall survival (OS) was 38% (95% CI: 33–44%). Relapse remained the leading cause of death accounting for 49% of all deaths. In univariate analysis, 3 year risk of NRM was significantly higher with reduced Karnofsky performance status (KPS P = 0.006). Mortality was increased in older adults (66+ vs. 55–60: Relative Risk [RR] 1.51 95% CI: 1.00–2.29, P = 0.05) and those with advanced disease (RR 2.13; 95% CI: 1.36–3.34, P = 0.001). Survival of patients in CR1 yields 45% (95% CI: 38–52%) at 3 years and no relapse occurred after 2 years. We report promising OS and acceptable NRM using RIC HCT in older patients with B‐ALL. Disease status in CR1 and good performance status are associated with improved outcomes. Am. J. Hematol. 92:42–49, 2017. © 2016 Wiley Periodicals, Inc.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Nov 12, 2016
- Source ID
- 10.1002/ajh.24575
Entities
People
- Andrew Artz
- Armin Rashidi
- Ashley E. Rosko
- Brenda Sandmaier
- Christopher Bredeson
- Daniel J Weisdorf
- David I. Marks
- H. Jean Khoury
- Hailin Wang
- Hillard M Lazarus
- Ian Nivison‐smith
- Johnathan Brammer
- Joseph McGuirk
- Marcos de Lima
- Matthew Seftel
- Mohamed Kharfan‐dabaja
- Mohamed Mohty
- Olle Ringden
- Rodrigo Martino Bufarull
- Sherif Farag
- Taiga Nishihori
- Veronika Bachanova
- Wael Saber
Organizations
- Barnes-Jewish Hospital
- Emory University
- Hospital de Sant Pau
- Indiana University
- Karolinska Institutet
- Medical College of Wisconsin
- Office of Naval Research
- Ohio State University
- Princess Margaret Cancer Centre
- St Vincent's Hospital
- The Ottawa Hospital
- The University of Texas MD Anderson Cancer Center
- UH Cleveland Medical Center
- University of Chicago
- University of Kansas
- University of Minnesota
- University of Washington