Pediatric-inspired therapy compared to allografting for Philadelphia chromosome-negative adult ALL in first complete remission Journal Article


Authors: Seftel, M. D.; Neuberg, D.; Zhang, M. J.; Wang, H. L.; Ballen, K. K.; Bergeron, J.; Couban, S.; Freytes, C. O.; Hamadani, M.; Kharfan-Dabaja, M. A.; Lazarus, H. M.; Nishihori, T.; Paulson, K.; Saber, W.; Sallan, S. E.; Soiffer, R.; Tallman, M. S.; Woolfrey, A. E.; DeAngelo, D. J.; Weisdorf, D. J.; Acute Leukemia Committee of the CIBMTR; Dana Farber ALL Consortium
Article Title: Pediatric-inspired therapy compared to allografting for Philadelphia chromosome-negative adult ALL in first complete remission
Abstract: For adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) in first complete remission (CR1), allogeneic hematopoietic cell transplantation (HCT) is an established curative strategy. However, pediatric-inspired chemotherapy may also offer durable leukemia-free survival in the absence of HCT. We compared 422 HCT recipients aged 18-50 years with Ph-ALL in CR1 reported to the CIBMTR with an age-matched concurrent cohort of 108 Ph- ALL CR1 patients who received a Dana-Farber Consortium pediatric-inspired non-HCT regimen. At 4 years of follow-up, incidence of relapse after HCT was 24% (95% CI 19-28) versus 23% (95% CI 15-32) for the non-HCT (chemo) cohort (P=0.97). Treatment-related mortality (TRM) was higher in the HCT cohort [HCT 37% (95% CI 31-42) versus chemo 6% (95% CI 3-12), P<0.0001]. DFS in the HCT cohort was 40% (95% CI 35-45) versus 71% (95% CI 60-79) for chemo, P<0.0001. Similarly, OS favored chemo [HCT 45% (95% CI 40-50)] versus chemo 73% [(95% CI 63-81), P<0.0001]. In multivariable analysis, the sole factor predictive of shorter OS was the administration of HCT [hazard ratio 3.12 (1.99-4.90), P<0.0001]. For younger adults with Ph- ALL, pediatric-inspired chemotherapy had lower TRM, no increase in relapse, and superior overall survival compared to HCT. © 2016 Wiley Periodicals, Inc.
Journal Title: American Journal of Hematology
Volume: 91
Issue: 3
ISSN: 0361-8609
Publisher: John Wiley & Sons, Inc.  
Date Published: 2016-03-01
Start Page: 322
End Page: 329
Language: English
DOI: 10.1002/ajh.24285
PROVIDER: scopus
PMCID: PMC4764423
PUBMED: 26701142
DOI/URL:
Notes: Article -- Export Date: 4 April 2016 -- Source: Scopus
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  1. Martin Stuart Tallman
    504 Tallman