EFFICACY OF CONSOLIDATION CHEMOTHERAPY FOR PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKEMIA WHO ACHIEVED COMPLETE REMISSION BY FIRST COURSE OF REMISSION INDUCTION THERAPY.
Author(s): ,
Akio Shigematsu
Affiliations:
Department of Hematology,Sappro Hokuyu Hospital,Sapporo,Japan
,
Shuichi Ota
Affiliations:
Department of Hematology,Sapporo Hokuyu Hospital,Sapporo,Japan
,
Ryoji Kobayashi
Affiliations:
Department of Pediatrics,Sappro Hokuyu Hospital,Sapporo,Japan
,
Takeshi Kondo
Affiliations:
Blood Disorders Center, Department of Hematology,Aiiku Hospital,Sapporo,Japan
,
Tomoyuki Endo
Affiliations:
Department of Hematology,Hokkaido University School of Medicine,Sapporo,Japan
,
Yutaka Tsutsumi
Affiliations:
Department of Hematology,Hakodate Municipal Hospital,Hakodate,Japan
,
Hajime Kobayashi
Affiliations:
Department of Hematology,Obihiro Kosei Hospital,Obihiro,Japan
,
Yasukata Kakinoki
Affiliations:
Department of Hematology,Asahikawa City Hospital,Asahikawa,Japan
,
Satoshi Yamamoto
Affiliations:
Department of Hematology,Sapporo City General Hospital,Sapporo,Japan
,
Yuichi Konuma
Affiliations:
Department of Hematology/Oncology,Asahikawa Red Cross Hospital,Asahikawa,Japan
,
Takuto Miyagishima
Affiliations:
Department of Hematology,Kushiro Rosai Hospital,Kushiro,Japan
,
Tetsuyuki Igarashi
Affiliations:
Department of Hematology,Tenshi Hospital,Sapporo,Japan
,
Takanori Oda
Affiliations:
Department of Hematology/Oncology,Hokkaido Medical Center for Child Health and Rehabilitation,Sapporo,Japan
,
Hajime Sakai
Affiliations:
Department of Hematology,Teine Keijinkai Hospital,Sapporo,Japan
,
Toshimichi Ishihara
Affiliations:
Department of Hematology,Kin-ikyo Chuo Hospital,Sapporo,Japan
,
Masahiro Yoshida
Affiliations:
Department of Hematology/Oncology,Steel Memorial Muroran Hospital,Muroran,Japan
,
Takahiro Nagashima
Affiliations:
Department of Internal medicine,Japanese Red Cross Kitami Hospital,Kitami,Japan
,
Kazuya Sato
Affiliations:
Department of Hematology/Oncology,Asahikawa Kosei Hospital,Asahikawa,Japan
,
Yuji Kanisawa
Affiliations:
Department of Hematology/Oncology,Oji General Hospital,Tomakomai,Japan
,
Toshihito Haseyama
Affiliations:
Department of Hematology,Tonan Hospital,Sapporo,Japan
,
Yasuo Hirayama
Affiliations:
Department of Internal Medicine,Higashi Sapporo Hospital,Sapporo,Japan
Mitsutoshi Kurosawa
Affiliations:
Department of Hematology,National Hospital Organization, Hokkaido Cancer Center,Sapporo,Japan
EHA Library. Shigematsu A. Jun 14, 2019; 265974; PF184
Akio Shigematsu
Akio Shigematsu
Contributions
Abstract

Abstract: PF184

Type: Poster Presentation

Presentation during EHA24: On Friday, June 14, 2019 from 17:30 - 19:00

Location: Poster area

Background
Complete remission (CR) has been induced by multiagent remission induction therapies in the majority of patients with acute lymphoblastic leukemia (ALL). However, prognosis for adult patients with ALL has not been satisfactory due to a high rate of relapse, and the feasibility of post-remission consolidation therapy has been reported. Most treatment protocols include post-remission consolidation chemotherapy, however, it remains to be clarified whether consolidation is beneficial especially in patients who is considered to receive allogeneic hematopoietic stem cell transplantation (allo-HCT).

Aims
We retrospectively analyzed importance of consolidation chemotherapy in patients with ALL.

Methods
Clinical data for 312 patients aged more than 15 years who diagnosed as having ALL between 2007 and 2017 were collected from 21 centers in Hokkaido, Japan. Patients with lymphoblastic lymphoma and Burkitt leukemia, and patients who did not achieve CR by first induction remission chemotherapy were excluded from this study.

Results
The median age of the patients was 55 years (range: 15-84 years). Sixty-three patients were AYA (15-35 years), 163 were adult (36-65 years) and 86 were elderly patients (66- years). BCR-ABL was positive in 158 patients. After a first remission induction therapy, 192 of 216 evaluable patients achieved cytogenetic CR, and 74 of 121 evaluable patients achieved molecular CR.

Consolidation chemotherapies were administered for 264 of the patients. In the 49 patients who did not receive consolidation, 37 patients were BCR-ABL positive and 12 patients were BCR-ABL negative. Older age, poor performance status and BCR-ABL positivity were associated with not receiving consolidation.

 At the median follow-up of 1092 days (54-3914 days), overall survival (OS) and progression-free survival (PFS) were significantly superior in patients who received at least one course of consolidation therapy (P<0.001, Figure). However, in the patients with BCR-ABL who received tyrosine kinase inhibitor (TKI) as maintenance therapy, consolidation chemotherapy was not associated with OS (P=0.19). Among the patients who did not receive allo-HCT at CR1, larger number of consolidation chemotherapy was associated with superior survival. Among patients who received allo-HCT at CR1, the number of consolidation chemotherapy was not associated with OS (P=0.825). 

Conclusion
Consolidation chemotherapy was associated with better survival in patients with ALL. However, in patients with BCR-ABL or in patients considered allo-SCT, consolidation chemotherapy was not associated with better survival. We need to consider maintenance TKI therapy without consolidation for BCR-ABL positive patients and early allo-SCT for candidates of transplantation. 

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Acute lymphoblastic leukemia, Consolidation, Stem cell transplant

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