Value of pre-transplant consolidation chemotherapy in adults with acute lymphoblastic leukemia undergoing allogeneic hematopoietic stem cell transplantation without minimal residual disease in first complete remission

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is recommended for adults acute lymphoblastic leukemia (ALL) with minimal residual disease (MRD) negative during their first complete remission (CR1). However, the role of pre-transplant consolidation chemotherapy remains unclear. We evaluated 78 CR1/MRD-negative patients, the consolidation and non-consolidation groups had similar 5-year OS (74.8% [95% CI: 62.2–87.3%] vs. 74.2% [95% CI: 53.2–95.1%], p = .894), RFS (72.2% [95% CI: 59.6–84.7%] vs. 73.1% [95% CI: 54.2–91.9%], p = .942), CIR (9.4% [95% CI: 9.1–9.7%] vs. 18.9% [95% CI: 17.3–20.4%], p = .376), and NRM (18.4% [95% CI: 17.7–19.0%] vs. 8.0% [95% CI: 7.3–8.6%], p = .375). Multivariable analysis confirmed that high cytogenetic risk independently predicted poor OS and RFS, although pre-transplant consolidation chemotherapy did not predict the prognosis. Based on these findings, we recommend performing transplantation immediately for adult ALL patients after they have achieved CR1/MRD-negative status when there are readily available donors.

Keywords:

• Acute lymphoblastic leukemia
• minimal residual disease
• consolidation chemotherapy
• allogeneic hematopoietic cell transplantation
• prognosis

Acknowledgments

WF collected and verified the patient information, analyzed and interpreted the data. AH and GL collected and analyzed the data. XN, LG, LC, JC, WZ, and JY diagnosed and treated the patients. JY designed the research, interpreted the data, and critically wrote and reviewed the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The present research was financially supported by National Natural Science Foundation of China [NSFC; 81770209].