Pretransplant consolidation is not beneficial for adults with ALL undergoing myeloablative allogeneic transplantation Journal Article


Authors: Bejanyan, N.; Zhang, M. J.; Wang, H. L.; Lazaryan, A.; de Lima, M.; Marks, D. I.; Sandmaier, B. M.; Bachanova, V.; Rowe, J.; Tallman, M.; Kebriaei, P.; Kharfan-Dabaja, M.; Gale, R. P.; Lazarus, H. M.; Ustun, C.; Copelan, E.; Hamilton, B. K.; Schiller, G.; Hogan, W.; Hashmi, S.; Seftel, M.; Kanakry, C. G.; Olsson, R. F.; Martino, R.; Saber, W.; Khoury, H. J.; Weisdorf, D. J.
Article Title: Pretransplant consolidation is not beneficial for adults with ALL undergoing myeloablative allogeneic transplantation
Abstract: Allogeneic hematopoietic cell transplantation (alloHCT) is curative for patients with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR1) with chemotherapy. However, the benefit of consolidation chemotherapy remains uncertain in patients undergoing alloHCT. We compared clinical outcomes of 524 adult patients with ALL in CR1 who received ≥2 (n = 109), 1 (n = 93), or 0 cycles (n = 322) of consolidation before myeloablative alloHCT from 2008 to 2012. As expected, time to alloHCT was longer with increasing cycles of consolidation. Patients receiving ≥2, 1, or 0 cycles of consolidation had an adjusted 3-year cumulative incidence of relapse of 20%, 27%, and 22%; 1-year transplant-related mortality (TRM) of 16%, 18%, and 23%; adjusted 3-year leukemia-free survival (LFS) of 54%, 48%, and 47%; and 3-year overall survival (OS) of 63%, 59%, and 54% (all P values >.40). Multivariable analysis confirmed that consolidation was not prognostic for LFS (relative risk, 1.20, 95% confidence interval,.86 to 1.67; P =.28 for no consolidation; RR, 1.18, 95% confidence interval,.79 to 1.76; P =.41 for 1 cycle versus ≥2 cycles = reference). Similarly, consolidation was not associated with OS, relapse, TRM, or graft-versus-host disease. We conclude that consolidation chemotherapy does not appear to provide added benefit in adult ALL patients with available donors who undergo myeloablative alloHCT in CR1. © 2017 The American Society for Blood and Marrow Transplantation
Keywords: myeloablative conditioning; allogeneic transplant; all; consolidation chemotherapy
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 24
Issue: 5
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2018-05-01
Start Page: 945
End Page: 955
Language: English
DOI: 10.1016/j.bbmt.2017.12.784
PROVIDER: scopus
PMCID: PMC5953798
PUBMED: 29275139
DOI/URL:
Notes: Article -- Export Date: 1 June 2018 -- Source: Scopus
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  1. Martin Stuart Tallman
    640 Tallman