Evaluation of allogeneic transplantation in first or later minimal residual disease – negative remission following adult-inspired therapy for acute lymphoblastic leukemia

Abstract

Comparisons without hematopoietic cell transplantation (HCT) to myeloablative (MAC) or reduced-intensity HCT (RIC) for adults with acute lymphoblastic leukemia (ALL) in first minimal-residual-disease negative remission (MRD^Neg CR1) are limited. Further, the importance of MRD^Neg following salvage therapy (MRD^Neg CR2+) is unknown. We evaluated 89 patients in MRD^Neg CR1 after adult-inspired treatment: 33 received MAC (12 Philadelphia chromosome [Ph]+), 17 received RIC (13 Ph+), and 39 Deferred HCT (3 Ph+). Three-year overall survival (OS) estimates for MAC, RIC, and Deferred HCT were 71%, 69%, and 68%, while 3-year event-free survival (EFS) estimates were 65%, 54%, and 28%, respectively. Further, HCT in MRD^Neg CR1 performed similarly to MRD^Neg CR2+: 3-year OS estimates were 70% and 69%, and 3-year EFS estimates were 62% and 62%, respectively. In conclusion, adults with ALL in MRD^Neg CR1 following adult-inspired therapy had similar OS with or without HCT, and HCT in MRD^Neg CR2 + can yield long-term survival.

Keywords:

• Chemotherapeutic approaches
• clinical results
• lymphoid leukemia
• marrow and stem cell transplantation
• neoplasia
• prognostication

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at http://dx.doi.org/10.3109/10428194.2016.1160080.