Universität zu Köln

Bazarbachi, Abdul Hamid, Al Hamed, Rama, Labopin, Myriam, Afanasyev, Boris, Hamladji, Rose-Marie, Beelen, Dietrich, Eder, Matthias, Scheid, Christof, Wu, Depei, Bunjes, Donald, Stepensky, Polina, Tischer, Johanna, Kroeger, Nicolaus, Peric, Zina, Aljurf, Mahmoud, Giebel, Sebastian ORCID: 0000-0002-4827-4401, Nagler, Arnon and Mohty, Mohamad (2020). Allogeneic stem-cell transplantation with sequential conditioning in adult patients with refractory or relapsed acute lymphoblastic leukemia: a report from the EBMT Acute Leukemia Working Party. Bone Marrow Transplant., 55 (3). S. 595 - 603. LONDON: NATURE PUBLISHING GROUP. ISSN 1476-5365

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Abstract

Treatment of relapsed/refractory acute lymphoblastic leukemia (RR-ALL) remains a clinical challenge with generally dismal prognosis. Allogeneic stem-cell transplantation using sequential conditioning (FLAMSA-like) has shown promising results in relapsed/refractory acute myeloid leukemia, but little is known about its efficacy in RR-ALL. We identified 115 patients (19-66 years) with relapsed (74%) or primary-refractory (26%) ALL allografted from matched related (31%), matched unrelated (58%), or haploidentical donor (11%). Median follow-up was 37 (13-111) months. At day 100, cumulative incidences of grade II-IV/III-IV acute graft-versus-host-disease (GVHD) were 30% and 17%, respectively. Two-year cumulative incidence of chronic GVHD was 25% with 11% extensive cases. Two-year relapse incidence (RI) was 45%, non-relapse mortality was 41%. Two-year leukemia free survival (LFS) was 14%, overall survival (OS) 17%, and GVHD relapse-free survival (GRFS) was 14%. In multivariable analysis, Karnofsky score <90 negatively affected RI, LFS, OS, and GRFS. Conditioning with chemotherapy alone, compared with total body irradiation (TBI) negatively affected RI (HR = 3.3; p = 0.008), LFS (HR = 1.94; p = 0.03), and OS (HR = 2.0; p = 0.03). These patients still face extremely poor outcomes, highlighting the importance of incorporating novel therapies (e.g., BITE antibodies, inotuzumab, CAR-T cells). Nevertheless, patients with RR-T-cell ALL remain with an unmet treatment need, for which TBI-based sequential conditioning could be one of few available options.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bazarbachi, Abdul Hamid UNSPECIFIED UNSPECIFIED UNSPECIFIED Al Hamed, Rama UNSPECIFIED UNSPECIFIED UNSPECIFIED Labopin, Myriam UNSPECIFIED UNSPECIFIED UNSPECIFIED Afanasyev, Boris UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamladji, Rose-Marie UNSPECIFIED UNSPECIFIED UNSPECIFIED Beelen, Dietrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Eder, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Scheid, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Wu, Depei UNSPECIFIED UNSPECIFIED UNSPECIFIED Bunjes, Donald UNSPECIFIED UNSPECIFIED UNSPECIFIED Stepensky, Polina UNSPECIFIED UNSPECIFIED UNSPECIFIED Tischer, Johanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroeger, Nicolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Peric, Zina UNSPECIFIED UNSPECIFIED UNSPECIFIED Aljurf, Mahmoud UNSPECIFIED UNSPECIFIED UNSPECIFIED Giebel, Sebastian UNSPECIFIED orcid.org/0000-0002-4827-4401 UNSPECIFIED Nagler, Arnon UNSPECIFIED UNSPECIFIED UNSPECIFIED Mohty, Mohamad UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-342859
DOI:	10.1038/s41409-019-0702-2
Journal or Publication Title:	Bone Marrow Transplant.
Volume:	55
Number:	3
Page Range:	S. 595 - 603
Date:	2020
Publisher:	NATURE PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1476-5365
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE MYELOID-LEUKEMIA; TOTAL-BODY IRRADIATION; VERSUS-HOST-DISEASE; REDUCED-INTENSITY; T-CELL; COMPLETE REMISSION; EUROPEAN-SOCIETY; CHEMOTHERAPY; REGIMEN; MARROW Multiple languages Biophysics; Oncology; Hematology; Immunology; Transplantation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34285