TY - JOUR
T1 - Residual disease is a strong prognostic marker in patients with acute lymphoblastic leukaemia with chemotherapy-refractory or relapsed disease prior to allogeneic stem cell transplantation
AU - Nakamura, Momoko
AU - Arai, Yasuyuki
AU - Hirabayashi, Shigeki
AU - Kondo, Tadakazu
AU - Doki, Noriko
AU - Uchida, Naoyuki
AU - Fukuda, Takahiro
AU - Ozawa, Yukiyasu
AU - Tanaka, Masatsugu
AU - Sawa, Masashi
AU - Katayama, Yuta
AU - Kanda, Yoshinobu
AU - Shiratori, Souichi
AU - Nakamae, Hirohisa
AU - Yoshioka, Satoshi
AU - Onizuka, Makoto
AU - Ichinohe, Tatsuo
AU - Atsuta, Yoshiko
AU - Kako, Shinichi
N1 - Funding Information:
HN received honoraria from Astellas Pharma, Inc., Takeda Pharmaceutical Company Ltd., Chugai Pharmaceutical Co., Ltd., and Pfizer Japan, Inc., and research funding from Astellas Pharma, Inc. TI received research funding from Abbie, Inc., Chugai Pharmaceutical Co., CSL Behring, Eisai Co., Kyowa Kirin Co., Ono Pharmaceutical Co., Nippon Shinyaku Co., Repertoire Genesis, Inc., Sumitomo Dainippon Pharma Co., Takeda Pharmaceutical Co., Zenyaku Kogyo Co., outside of this work. The other authors declare no competing financial interests.
Funding Information:
This work was supported, in part, by research funding from the Foundation for Promotion of Cancer Research, Japanese Society for Hematology, and Global Medical Grants by Pfizer awarded to Y. Arai.
Publisher Copyright:
© 2021 British Society for Haematology and John Wiley & Sons Ltd
PY - 2021/7
Y1 - 2021/7
N2 - Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is one of the curative treatment options for acute lymphoblastic leukaemia (ALL). However, the outcomes in patients transplanted without complete remission (non-CR) have not yet been fully reported, and detailed analyses are required to identify subgroups in which optimal prognosis is expected and to optimize pre-transplant therapeutic strategies. Hence, we performed a multicentred retrospective cohort study including a total of 663 adult ALL patients transplanted at non-CR status; the median bone marrow (BM) blast counts at HSCT was 13·2%, and 203 patients (30·6%) were treated at primary induction failure status. The overall survival (OS) was 31·1% at two years, and the multivariate analyses identified five prognostic risk factors, including older age (≥50 years), increased BM blasts (≥10%), poor performance status, high haematopoietic cell transplantation (HCT)-comorbidity index, and relapsed disease status, among which BM blast was the most significantly related. A predictive scoring system composed of these risk factors clearly stratified OS (15·6–59·5% at two years). In conclusion, this is the first large-scale study to analyze the correlation of patient characteristics with post-transplant prognosis in ALL transplanted at non-CR status. The importance of blast control before HSCT should be focused on for better patient prognosis.
AB - Allogeneic haematopoietic stem cell transplantation (allo-HSCT) is one of the curative treatment options for acute lymphoblastic leukaemia (ALL). However, the outcomes in patients transplanted without complete remission (non-CR) have not yet been fully reported, and detailed analyses are required to identify subgroups in which optimal prognosis is expected and to optimize pre-transplant therapeutic strategies. Hence, we performed a multicentred retrospective cohort study including a total of 663 adult ALL patients transplanted at non-CR status; the median bone marrow (BM) blast counts at HSCT was 13·2%, and 203 patients (30·6%) were treated at primary induction failure status. The overall survival (OS) was 31·1% at two years, and the multivariate analyses identified five prognostic risk factors, including older age (≥50 years), increased BM blasts (≥10%), poor performance status, high haematopoietic cell transplantation (HCT)-comorbidity index, and relapsed disease status, among which BM blast was the most significantly related. A predictive scoring system composed of these risk factors clearly stratified OS (15·6–59·5% at two years). In conclusion, this is the first large-scale study to analyze the correlation of patient characteristics with post-transplant prognosis in ALL transplanted at non-CR status. The importance of blast control before HSCT should be focused on for better patient prognosis.
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U2 - 10.1111/bjh.17646
DO - 10.1111/bjh.17646
M3 - Article
C2 - 34159580
AN - SCOPUS:85108251017
VL - 194
SP - 403
EP - 413
JO - British Journal of Haematology
JF - British Journal of Haematology
SN - 0007-1048
IS - 2
ER -