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

Matthew D. Seftel, Donna Neuberg, Mei Jie Zhang, Hai Lin Wang, Karen Kuhn Ballen, Julie Bergeron, Stephen Couban, César O. Freytes, Mehdi Hamadani, Mohamed A. Kharfan-Dabaja, Hillard M. Lazarus, Taiga Nishihori, Kristjan Paulson, Wael Saber, Stephen E. Sallan, Robert Soiffer, Martin S. Tallman, Ann E. Woolfrey, Daniel J. Deangelo, Daniel J. WeisdorfGorgun Akpek, Ulrike Bacher, Veronika Bachanova, Frederic Baron, Asad Bashey, Jean Yves Cahn, Bruce M. Camitta, Edward A. Copelan, Marcos De Lima, Abhinav Deol, Robert Peter Gale, Usama Gergis, William J. Hogan, Partow Kebriaei, Mark R. Litzow, Alison W. Loren, Alan M. Miller, Maxim Norkin, Richard F. Olsson, Ran Reshef, Mitchell Sabloff, Brenda M. Sandmaier, Bipin N. Savani, Harry C. Schouten, Ravi Vij, Peter H. Wiernik, Baldeep Wirk, William Allen1 Wood

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)322-329
Number of pages8
JournalAmerican Journal of Hematology
Volume91
Issue number3
DOIs
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
Anonymous donation to the Medical College of Wisconsin; Ariad; Be the Match Foundation; *Blue Cross and Blue Shield Association; *Celgene Corporation; Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Fresenius-Biotech North America, Inc.; *Gamida Cell Teva Joint Venture Ltd.; Genentech, Inc.;*Gentium SpA; Genzyme Corporation; GlaxoSmithKline; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Jeff Gordon Children''s Foundation; Kiadis Pharma; The Leukemia & Lymphoma Society; Medac GmbH; The Medical College of Wisconsin; Merck & Co, Inc.; Millennium: The Takeda Oncology Co.; *Milliman USA, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Osiris Therapeutics, Inc.; Otsuka America Pharmaceutical, Inc.; Perkin Elmer, Inc.; *Remedy Informatics; *Sanofi US; Seattle Genetics; Sigma-Tau Pharmaceuticals; Soligenix, Inc.; St. Baldrick''s Foundation; StemCyte, A Global Cord Blood Therapeutics Co.; Stemsoft Software, Inc.; Swedish Orphan Biovitrum; *Tarix Pharmaceuticals; *TerumoBCT; *Teva Neuroscience, Inc.; *THERAKOS, Inc.; University of Minnesota; University of Utah; and *Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the U.S. Government. *Corporate Members

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