Gene mutations and pretransplant minimal residual disease predict risk of relapse in adult patients after allogeneic hematopoietic stem-cell transplantation for T cell acute lymphoblastic leukemia

Abstract

We retrospectively analyzed outcomes of 120 hematopoietic stem cell transplantation (HSCT) patients with T cell acute lymphoblastic leukemia (T-ALL), with emphases on gene mutations and pre-transplant minimal residual disease (MRD). Patients with NOTCH1/FBXW7 (N/F) mutations but no RAS or PTEN abnormalities were considered genetic low risk (gLoR), whereas those with RAS/PTEN alterations or no N/F mutations were considered high risk (gHiR). The gLoR and gHiR groups differed significantly in 3-year CIR (gLoR: 12.4%, gHiR: 41.2%, p = .026) and RFS (gLoR: 80.7%, gHiR: 35.2%, p = .025). Patients with MRD at transplantation had significantly higher CIR rates than those with no MRD (56.7% vs 22.6%, p < .001). Among the 57.5% of patients with no MRD, 3-year CIR and RFS differed significantly between the gHiR and gLoR groups (CIR-gHiR: 38.7%, gLoR: 6.7%, p = .039; RFS-gHiR: 42.3%, gLoR: 86.1%, p = .012). Gene mutations and pretransplant MRD predict high risk of relapse and worse RFS in patients with T-ALL after HSCT.

Keywords:

• T cell acute lymphoblastic leukemia
• allogeneic hematopoietic cell transplantation
• minimal residual disease (MRD)
• gene mutations

Acknowledgments

We would like to thank all the patients, physicians and nurses from the Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University. This study was supported by the Innovation Capability Development Project of Jiangsu Province (No. BM2015004).

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http:\\<10.1080/10428194.2019.1597270>