Retrospective analyses of allo-HSCT for T-ALL prior to the use of pediatric-inspired regimens
| . | Group study . | ||||
|---|---|---|---|---|---|
| . | UKALL XII/E29934 . | ASBMT50 . | EBMT51 . | King Faisal Specialist Hospital and Research Center52 . | MDACC/OHSU/NUH53 . |
| Analysis | Retrospective | Retrospective | Retrospective | Retrospective | Retrospective |
| No. of T-ALL patients | 356 | 208 | 601 | 53 | 102 |
| Study period (date range) | 1993-2006 | 2000-2014 | 2000-2010 | 1995-2009 | 2000-2015 |
| Age range, years | 15-59 | 17-72 | 18-63 | 14-51 | 2-72 |
| ETP phenotype analysis | Noa | No | No | Noa | Yes |
| MRD analysis for risk stratification | No | No | No | No | Yes |
| Disease status at time of HSCT | CR1 100% | CR1 43%, CR2 + 39%, R/R 38% | CR1 72%, CR2 13%, CR2+ or R/R 15% | CR1 60.3%, CR2 + 34%, R/R 5.7% | CR1 37%, CR2 + 39%, PIF/CR1 6%, R/R 18% |
| Conditioning regimen | MAC + TBI 100% | MAC 84%, MAC + TBI 86% | MAC 100%, MAC with TBI 87% | MAC 100%, MAC + TBI 94.3% | MAC 77%, MAC + TBI 41% |
| Outcome measure | 5-y OS, CIR, RFS, donor vs no donor comparison | 1-y and 5-y OS, RR, RM, NRM, GVHD | Impact of TBI on MAC, 5-y OS, LFS, NRM | OS, DFS, relapse, NRM, aCVHD, cGVHD | OS, PFS, RR, NRM, aGVHD and cGVHD |
| Survival outcome | 5-y OS 48%, 2-y CIR 35%, 5-y CIR 42%, NRM 26% | 1-y OS 58%, 5-y OS 34% 1-y RR 35%, 5-y RR 42% 1-y RM 24%, 5-y RM 39% 1-y NRM 18%, 5-y NRM 27% aGVHD 3 mo 55%, cGVHD 1 y 28% | 5-y OS 45%, 5-y DFS 41%, 5-y NRM 25%, 5-y CIR 35%, aGVHD 3 m 38%, 5-y cGVHD 42% | 5-y OS 43.5%, 5-y DFS 41.8%, 5-y NRM 22.5%, aGVHD 40.2%, cGVHD 43.7%, 5-y CIR 35.6% | 3-y OS 35%, 3-y PFS 33%, CI of NRM was 5% at 100 d, 10% at 1 y and 11% at 3 y. CI disease progression 44% at 1 y and 55% at 3 y. 3-y OS for ETP was 29%, with CI disease progression 63% at 3 y. ETP + allo-HSCT in CR1, OS was 47% at 3 y. |
| Conclusion | Pts >35 y had inferior outcomes, no benefit to autologous HSCT, sibling donors had benefit over no sibling donor (RR 26% vs 50.9%) | Relapse is main cause of treatment failure. Disease status at time of transplant is most important risk factor for survival. TBI associated with better survival, especially in CR2. | Disease status at allo-HSCT is most important risk factor for survival. TBI associated with better survival (5-y LFS 44% vs 25%, 5-y OS 47% vs 28%, CIR 30% vs 60%), but only for pts <35 y. | Outcomes, relapse significantly associated with disease status at allo-HSCT | Relapse is main cause of treatment failure. Relapse significantly associated with disease status (MRD+) at allo-HSCT. Allo-HSCT can abrogate the negative prognostic impact of ETP-ALL. |
| . | Group study . | ||||
|---|---|---|---|---|---|
| . | UKALL XII/E29934 . | ASBMT50 . | EBMT51 . | King Faisal Specialist Hospital and Research Center52 . | MDACC/OHSU/NUH53 . |
| Analysis | Retrospective | Retrospective | Retrospective | Retrospective | Retrospective |
| No. of T-ALL patients | 356 | 208 | 601 | 53 | 102 |
| Study period (date range) | 1993-2006 | 2000-2014 | 2000-2010 | 1995-2009 | 2000-2015 |
| Age range, years | 15-59 | 17-72 | 18-63 | 14-51 | 2-72 |
| ETP phenotype analysis | Noa | No | No | Noa | Yes |
| MRD analysis for risk stratification | No | No | No | No | Yes |
| Disease status at time of HSCT | CR1 100% | CR1 43%, CR2 + 39%, R/R 38% | CR1 72%, CR2 13%, CR2+ or R/R 15% | CR1 60.3%, CR2 + 34%, R/R 5.7% | CR1 37%, CR2 + 39%, PIF/CR1 6%, R/R 18% |
| Conditioning regimen | MAC + TBI 100% | MAC 84%, MAC + TBI 86% | MAC 100%, MAC with TBI 87% | MAC 100%, MAC + TBI 94.3% | MAC 77%, MAC + TBI 41% |
| Outcome measure | 5-y OS, CIR, RFS, donor vs no donor comparison | 1-y and 5-y OS, RR, RM, NRM, GVHD | Impact of TBI on MAC, 5-y OS, LFS, NRM | OS, DFS, relapse, NRM, aCVHD, cGVHD | OS, PFS, RR, NRM, aGVHD and cGVHD |
| Survival outcome | 5-y OS 48%, 2-y CIR 35%, 5-y CIR 42%, NRM 26% | 1-y OS 58%, 5-y OS 34% 1-y RR 35%, 5-y RR 42% 1-y RM 24%, 5-y RM 39% 1-y NRM 18%, 5-y NRM 27% aGVHD 3 mo 55%, cGVHD 1 y 28% | 5-y OS 45%, 5-y DFS 41%, 5-y NRM 25%, 5-y CIR 35%, aGVHD 3 m 38%, 5-y cGVHD 42% | 5-y OS 43.5%, 5-y DFS 41.8%, 5-y NRM 22.5%, aGVHD 40.2%, cGVHD 43.7%, 5-y CIR 35.6% | 3-y OS 35%, 3-y PFS 33%, CI of NRM was 5% at 100 d, 10% at 1 y and 11% at 3 y. CI disease progression 44% at 1 y and 55% at 3 y. 3-y OS for ETP was 29%, with CI disease progression 63% at 3 y. ETP + allo-HSCT in CR1, OS was 47% at 3 y. |
| Conclusion | Pts >35 y had inferior outcomes, no benefit to autologous HSCT, sibling donors had benefit over no sibling donor (RR 26% vs 50.9%) | Relapse is main cause of treatment failure. Disease status at time of transplant is most important risk factor for survival. TBI associated with better survival, especially in CR2. | Disease status at allo-HSCT is most important risk factor for survival. TBI associated with better survival (5-y LFS 44% vs 25%, 5-y OS 47% vs 28%, CIR 30% vs 60%), but only for pts <35 y. | Outcomes, relapse significantly associated with disease status at allo-HSCT | Relapse is main cause of treatment failure. Relapse significantly associated with disease status (MRD+) at allo-HSCT. Allo-HSCT can abrogate the negative prognostic impact of ETP-ALL. |
Immunophenotypic analysis in this trial was suggestive of ETP phenotype (CD13+/CD1a−, but it was not yet defined as a subtype.
aGVHD, acute graft-versus-host disease; ASBMT, American Society for Blood and Marrow Transplantation; cGVHD, chronic graft-versus-host disease; CI, cumulative incidence; CIR, cumulative incidence of relapse; EBMT, European Group for Blood and Marrow Transplantation; LFS, leukemia free survival; NRM, nonrelapse mortality; NUH; National University Cancer Institute of Singapore; OHSU, Oregon Health and Science University; PIF, primary induction failure; pts, patients; RFS, relapse-free survival; RM, relapse mortality; TRM, treatment-related mortality.