IMPACT OF DISEASE STATUS ON OUTCOMES OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN THE TREATMENT OF REFRACTORY AND RELAPSED ACUTE LYMPHOBLASTIC LEUKEMIA
(Abstract release date: 05/19/16)
EHA Library. Tang X. 06/09/16; 135085; PB2185
Prof. Dr. Xiaowen Tang
Contributions
Contributions
Abstract
Abstract: PB2185
Type: Publication Only
Background
Treatment of refractory and relapsed acute lymphoblastic leukemia (ALL) remains challenging. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potential curative approach for these patients. However, whether patients will benefit by achieving remission before transplant remains controversial.
Aims
To evaluate the impact of disease status on the outcomes of allo-HSCT in the treatment of patients with refractory and relapsed ALL.
Methods
We retrospectively analyzed the outcome of 52 patients with refractory and relapsed ALL, including 19 cases in advanced stage, such as: nonremission (NR) and 33 cases in more than second complete remission (≥CR2), who underwent allo-HSCT after myeloablative conditioning regimen in our department.
Results
51 patients engrafted successfully, the transplantation-related mortality (TRM) rate of NR and ≥CR2 was 10.5% vs 12.1% (P=0.815). The incidence of acute GVHD(aGVHD) was 52.6% vs 57.6% (P=0.730), including 42.1% vs 33.3% (P=0.527) with mild (grade I-II) aGVHD and 10.5% vs 24.3% (P=0.399) with severe (grade III-IV) aGVHD,and chronic GVHD(cGVHD) was 41.6% vs 57.9% (P=0.660). With a median follow-up of 12(1.8-44.5) months, the cumulative relapse rate was 47% vs 34.3%（P=0.425) of NR and ≥CR2. The estimated 2 year overall survival (OS) and 2 year leukemia-free survival (LFS) rate were 42.6% vs 45.7% (P=0.487) and 46.3% vs 46.2% (P=0.571) respectively. Multi-parameter analysis results showed that, OS and LFS was significantly better in patients with the appearance of cGVHD．For relapsed patients, OS was significantly better with first CR duration>6 month and time to transplant≤2 months.
Conclusion
In this retrospective single center study, we can distinctly note that the survival of patients in NR and ≥CR2 before transplant is similar. Thus, it is suggested that allo-HSCT is an effective salvage therapy for patients with refractory and relapsed ALL and transplantation can be conducted directly for those who could not tolerate salvage chemotherapy. However, given the limited number of patients and observation time, an expanded sample size and prospective cohort study is needed to confirm the results.
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplant, Refractory, Relapse
Type: Publication Only
Background
Treatment of refractory and relapsed acute lymphoblastic leukemia (ALL) remains challenging. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potential curative approach for these patients. However, whether patients will benefit by achieving remission before transplant remains controversial.
Aims
To evaluate the impact of disease status on the outcomes of allo-HSCT in the treatment of patients with refractory and relapsed ALL.
Methods
We retrospectively analyzed the outcome of 52 patients with refractory and relapsed ALL, including 19 cases in advanced stage, such as: nonremission (NR) and 33 cases in more than second complete remission (≥CR2), who underwent allo-HSCT after myeloablative conditioning regimen in our department.
Results
51 patients engrafted successfully, the transplantation-related mortality (TRM) rate of NR and ≥CR2 was 10.5% vs 12.1% (P=0.815). The incidence of acute GVHD(aGVHD) was 52.6% vs 57.6% (P=0.730), including 42.1% vs 33.3% (P=0.527) with mild (grade I-II) aGVHD and 10.5% vs 24.3% (P=0.399) with severe (grade III-IV) aGVHD,and chronic GVHD(cGVHD) was 41.6% vs 57.9% (P=0.660). With a median follow-up of 12(1.8-44.5) months, the cumulative relapse rate was 47% vs 34.3%（P=0.425) of NR and ≥CR2. The estimated 2 year overall survival (OS) and 2 year leukemia-free survival (LFS) rate were 42.6% vs 45.7% (P=0.487) and 46.3% vs 46.2% (P=0.571) respectively. Multi-parameter analysis results showed that, OS and LFS was significantly better in patients with the appearance of cGVHD．For relapsed patients, OS was significantly better with first CR duration>6 month and time to transplant≤2 months.
Conclusion
In this retrospective single center study, we can distinctly note that the survival of patients in NR and ≥CR2 before transplant is similar. Thus, it is suggested that allo-HSCT is an effective salvage therapy for patients with refractory and relapsed ALL and transplantation can be conducted directly for those who could not tolerate salvage chemotherapy. However, given the limited number of patients and observation time, an expanded sample size and prospective cohort study is needed to confirm the results.
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplant, Refractory, Relapse
Abstract: PB2185
Type: Publication Only
Background
Treatment of refractory and relapsed acute lymphoblastic leukemia (ALL) remains challenging. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potential curative approach for these patients. However, whether patients will benefit by achieving remission before transplant remains controversial.
Aims
To evaluate the impact of disease status on the outcomes of allo-HSCT in the treatment of patients with refractory and relapsed ALL.
Methods
We retrospectively analyzed the outcome of 52 patients with refractory and relapsed ALL, including 19 cases in advanced stage, such as: nonremission (NR) and 33 cases in more than second complete remission (≥CR2), who underwent allo-HSCT after myeloablative conditioning regimen in our department.
Results
51 patients engrafted successfully, the transplantation-related mortality (TRM) rate of NR and ≥CR2 was 10.5% vs 12.1% (P=0.815). The incidence of acute GVHD(aGVHD) was 52.6% vs 57.6% (P=0.730), including 42.1% vs 33.3% (P=0.527) with mild (grade I-II) aGVHD and 10.5% vs 24.3% (P=0.399) with severe (grade III-IV) aGVHD,and chronic GVHD(cGVHD) was 41.6% vs 57.9% (P=0.660). With a median follow-up of 12(1.8-44.5) months, the cumulative relapse rate was 47% vs 34.3%（P=0.425) of NR and ≥CR2. The estimated 2 year overall survival (OS) and 2 year leukemia-free survival (LFS) rate were 42.6% vs 45.7% (P=0.487) and 46.3% vs 46.2% (P=0.571) respectively. Multi-parameter analysis results showed that, OS and LFS was significantly better in patients with the appearance of cGVHD．For relapsed patients, OS was significantly better with first CR duration>6 month and time to transplant≤2 months.
Conclusion
In this retrospective single center study, we can distinctly note that the survival of patients in NR and ≥CR2 before transplant is similar. Thus, it is suggested that allo-HSCT is an effective salvage therapy for patients with refractory and relapsed ALL and transplantation can be conducted directly for those who could not tolerate salvage chemotherapy. However, given the limited number of patients and observation time, an expanded sample size and prospective cohort study is needed to confirm the results.
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplant, Refractory, Relapse
Type: Publication Only
Background
Treatment of refractory and relapsed acute lymphoblastic leukemia (ALL) remains challenging. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potential curative approach for these patients. However, whether patients will benefit by achieving remission before transplant remains controversial.
Aims
To evaluate the impact of disease status on the outcomes of allo-HSCT in the treatment of patients with refractory and relapsed ALL.
Methods
We retrospectively analyzed the outcome of 52 patients with refractory and relapsed ALL, including 19 cases in advanced stage, such as: nonremission (NR) and 33 cases in more than second complete remission (≥CR2), who underwent allo-HSCT after myeloablative conditioning regimen in our department.
Results
51 patients engrafted successfully, the transplantation-related mortality (TRM) rate of NR and ≥CR2 was 10.5% vs 12.1% (P=0.815). The incidence of acute GVHD(aGVHD) was 52.6% vs 57.6% (P=0.730), including 42.1% vs 33.3% (P=0.527) with mild (grade I-II) aGVHD and 10.5% vs 24.3% (P=0.399) with severe (grade III-IV) aGVHD,and chronic GVHD(cGVHD) was 41.6% vs 57.9% (P=0.660). With a median follow-up of 12(1.8-44.5) months, the cumulative relapse rate was 47% vs 34.3%（P=0.425) of NR and ≥CR2. The estimated 2 year overall survival (OS) and 2 year leukemia-free survival (LFS) rate were 42.6% vs 45.7% (P=0.487) and 46.3% vs 46.2% (P=0.571) respectively. Multi-parameter analysis results showed that, OS and LFS was significantly better in patients with the appearance of cGVHD．For relapsed patients, OS was significantly better with first CR duration>6 month and time to transplant≤2 months.
Conclusion
In this retrospective single center study, we can distinctly note that the survival of patients in NR and ≥CR2 before transplant is similar. Thus, it is suggested that allo-HSCT is an effective salvage therapy for patients with refractory and relapsed ALL and transplantation can be conducted directly for those who could not tolerate salvage chemotherapy. However, given the limited number of patients and observation time, an expanded sample size and prospective cohort study is needed to confirm the results.
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Allogeneic hematopoietic stem cell transplant, Refractory, Relapse
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