Contributions
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Lehar 1 + 2
Background
ALL is rare in patients older than 60 years, and is associated with poor prognosis with chemotherapy alone, with reported leukemia-free survival (LFS) rates below 20%. When feasible, allogeneic stem cell transplantation (allo-SCT) is an attractive treatment option for those patients. However due to comorbidites, non-relapse mortality (NRM) can be a limiting factor.
Aims
This study aimed to evaluate the results and risk factors associated with outcome of allo-SCT in ALL patients older than 60 years, and who received a reduced-intensity conditioning (RIC) regimen prior to allo-SCT between 2001 and 2012.
Methods
117 patients with fully documented data could be identified and analyzed. Median age at time of allo-SCT was 63 (range, 60-75) years, with 34 patients (29%) being older than 65. 57% of patients had a Karnosky performance status ≥ 90%. Median year of allo-SCT was 2009. Median follow up was 37 (range, 10-134) m. 82 patients (70%) were transplanted in CR1, 19 (16%) in CR2 and CR3, and 16 (14%) in more advanced disease. Of 109 patients with available cytogenetics data, 53 (49%) harboured t(9;22) at diagnosis. Conditioning regimen included fludarabine and busulfan (Bu-Flu) for 34% of patients, 26% had a low-dose TBI-based regimen, while 20% received fludarabine and melphalan. ATG was used in 41% of cases. Fifty-two (45%) of patients were transplanted with an HLA-identical-sibling donor (MSD). Graft source was peripheral blood stem cells in 95% of cases.
Results
At 2 years the probabilities of LFS, and overall survival (OS) were 35% and 47%, respectively. The cumulative incidences (CI) of NRM, relapse incidence (RI), and chronic GVHD were 22%, 43%, and 38%, respectively. In univariate analysis, disease status was associated with LFS, RI and OS: LFS rate was 25% for CR2 and 13% for advanced vs 41% for CR1 (p<0.01), RI rate was 70% for CR2 and 63% for advanced vs 33% for CR1 (p<0.01), OS rate 40% for CR2 and 19% for advanced vs 54% for CR1 (p<0.01). Patients transplanted from a MSD had a higher RI (56% vs 33%) compared to those transplanted from unrelated donors (UD, p<0.01). Factors associated with NRM were the use of Bu-Flu (NRM was 13% for Bu-Flu vs 26% in other regimens) (p=0.05)) and Karnofsky-score ≥90% (NRM was 14% for KPS<90% vs 31% KPS ≥ 90%) (p<0.05)). In multivariate analysis, factors associated with LFS were disease status (advanced disease, HR=3.6, p<0.01) and CR2, HR=1.90, p=0.04), and the use of unrelated donors (HR=0.60, p=0.03). Disease status was associated with better OS (HR=0.28, p<0.001). On the other hand, advanced disease status, use of a MSD, performance status <90% was associated with a higher RI (HR=4.64, p<0.01, HR=2.38, p=0.06, HR=2.25, p<0.05 respectively). NRM was lower for patients with performance status ≥90% and for those receiving the Bu-Flu regimen (HR=0.48, p=0.06 and HR=0.33, p<0.05, respectively).
Summary
Allo-SCT after RIC is a feasible and effective option for patients with ALL older than 60 years with LFS of 35% and OS of 47%. The results were better for patients transplanted in CR1, and with good performance status.
Keyword(s): Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplant, Elderly
Session topic: Stem cell transplantation: Clinical 1
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Lehar 1 + 2
Background
ALL is rare in patients older than 60 years, and is associated with poor prognosis with chemotherapy alone, with reported leukemia-free survival (LFS) rates below 20%. When feasible, allogeneic stem cell transplantation (allo-SCT) is an attractive treatment option for those patients. However due to comorbidites, non-relapse mortality (NRM) can be a limiting factor.
Aims
This study aimed to evaluate the results and risk factors associated with outcome of allo-SCT in ALL patients older than 60 years, and who received a reduced-intensity conditioning (RIC) regimen prior to allo-SCT between 2001 and 2012.
Methods
117 patients with fully documented data could be identified and analyzed. Median age at time of allo-SCT was 63 (range, 60-75) years, with 34 patients (29%) being older than 65. 57% of patients had a Karnosky performance status ≥ 90%. Median year of allo-SCT was 2009. Median follow up was 37 (range, 10-134) m. 82 patients (70%) were transplanted in CR1, 19 (16%) in CR2 and CR3, and 16 (14%) in more advanced disease. Of 109 patients with available cytogenetics data, 53 (49%) harboured t(9;22) at diagnosis. Conditioning regimen included fludarabine and busulfan (Bu-Flu) for 34% of patients, 26% had a low-dose TBI-based regimen, while 20% received fludarabine and melphalan. ATG was used in 41% of cases. Fifty-two (45%) of patients were transplanted with an HLA-identical-sibling donor (MSD). Graft source was peripheral blood stem cells in 95% of cases.
Results
At 2 years the probabilities of LFS, and overall survival (OS) were 35% and 47%, respectively. The cumulative incidences (CI) of NRM, relapse incidence (RI), and chronic GVHD were 22%, 43%, and 38%, respectively. In univariate analysis, disease status was associated with LFS, RI and OS: LFS rate was 25% for CR2 and 13% for advanced vs 41% for CR1 (p<0.01), RI rate was 70% for CR2 and 63% for advanced vs 33% for CR1 (p<0.01), OS rate 40% for CR2 and 19% for advanced vs 54% for CR1 (p<0.01). Patients transplanted from a MSD had a higher RI (56% vs 33%) compared to those transplanted from unrelated donors (UD, p<0.01). Factors associated with NRM were the use of Bu-Flu (NRM was 13% for Bu-Flu vs 26% in other regimens) (p=0.05)) and Karnofsky-score ≥90% (NRM was 14% for KPS<90% vs 31% KPS ≥ 90%) (p<0.05)). In multivariate analysis, factors associated with LFS were disease status (advanced disease, HR=3.6, p<0.01) and CR2, HR=1.90, p=0.04), and the use of unrelated donors (HR=0.60, p=0.03). Disease status was associated with better OS (HR=0.28, p<0.001). On the other hand, advanced disease status, use of a MSD, performance status <90% was associated with a higher RI (HR=4.64, p<0.01, HR=2.38, p=0.06, HR=2.25, p<0.05 respectively). NRM was lower for patients with performance status ≥90% and for those receiving the Bu-Flu regimen (HR=0.48, p=0.06 and HR=0.33, p<0.05, respectively).
Summary
Allo-SCT after RIC is a feasible and effective option for patients with ALL older than 60 years with LFS of 35% and OS of 47%. The results were better for patients transplanted in CR1, and with good performance status.
Keyword(s): Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplant, Elderly
Session topic: Stem cell transplantation: Clinical 1