LONG-TERM OUTCOME OF ALLOGENEIC-HCT IN ADULT PATIENTS WITH ALL IN FIRST REMISSION; FAVORABLE GVHD-AND-RELAPSE-FREE SURVIVAL OF DOUBLE CORD BLOOD TRANSPLANTATION COMPARED TO CONVENTIONAL DONOR TYPES
Author(s): ,
Joonyeop Lee
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
,
Jae-ho Yoon
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
,
Seog Yun Yoon
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
,
Changgon Kim
Affiliations:
Division of Hematology & Oncology, Department of Internal Medicine, Soonchunhyang University, College of Medicine, Seoul Hospital,Seoul,Korea, Republic Of
,
Gi june Min
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
,
Ki-seong Eom
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
,
Hee-je Kim
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
,
Jong Wook Lee
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
Seok Lee
Affiliations:
Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Seoul,Korea, Republic Of
EHA Library. Lee J. Jun 15, 2019; 267245; PS944
Dr. Joonyeop Lee
Dr. Joonyeop Lee
Contributions
Abstract

Abstract: PS944

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Standard therapy for adult patients with high-risk acute lymphoblastic leukemia (ALL) is allogeneic-hematopoietic cell transplantation (HCT) from a matched-sibling (MSD) or matched unrelated donor (MUD). When the conventional donor is not available, HCT from a partially-mismatched unrelated donor (MMUD), cord blood transplantation (CBT), or familial haploidentical mismatched transplantation (FMMT) are considered

Aims
We analyzed long-term HCT outcomes according to the donor types including MMUD-HCT and double-CBT (DCBT) as an alternative choice compared to the conventional donor transplantation.

Methods
We initially enrolled 440 adult ALL patients who underwent transplantation from 2005 to 2015 in their first remission (CR1). Before 2010, our post-remission strategy for high-risk ALL was to offer allogeneic-HCT according to the donor availability (MSD or MUD) and sometimes used MMUD for next step. After 2010, DCBT was mainly used as an alternative choice. Conditioning regimen for DCBT was TBI, ARA-C and fludarabine. Graft-versus-host disease (GVHD)  prophylaxis was attempted by administering calcineurin inhibitors (cyclosporine for MSD, tacrolimus for others) plus methotrexate. Antithymocyte globulin (ATG) was administered to the patients who received grafts from MMUD.

Results
Engraftment was successful in all donor types, but neutrophil and platelet recovery was significantly delayed only after DCBT (median recovery for neutrophil and platelet was 25 and 33.5 days respectively). After median follow-up of 58.1 months (range, 6.5-145.7), 5-year OS for the entire 440 patients was 58.3%. In detail, 5-year OS for MSD, MUD, MMUD, and DCBT was 60.1%, 57.2%, 62.9%, and 65.1% (p=0.918). DCBT showed significantly higher NRM rate (29.6%) and lower relapse rate (7.2%). Interestingly, calculated GVHD and relapse-free survival (GRFS) for MSD, MUD, MMUD, and DCBT was 33.1%, 14.5%, 42.1%, and 50.3% (p = 0.001), respectively, which was related with higher incidence of severe chronic GVHD in MUD (30.1%) and MSD (14.8%) compared to DCBT (4.2%, p < 0.001). In high-risk subgroup (n=379) including 200 Philadelphia chromosome (Ph)-positive ALL, 5-year OS for MSD, MUD, MMUD, and DCBT was 57.9%, 58.5%, 59.2%, and 60.7%, but the 5-year GRFS was 29.7%, 14.0%, 36.5%, and 47.7%, respectively, which was related with lower relapse rate (8.7%) and low severe chronic GVHD (2.6%) of DCBT subgroup. Multivariate analysis showed that younger age < 40 yrs and mild to moderate chronic GVHD was related with favorable OS and GRFS, while MUD-HCT and severe chronic GVHD were related with poor GRFS.

Conclusion
Our data showed similar transplant outcomes of alternative donors such as DCBT and ATG-applied MMUD compared to conventional donor transplants in ALL patients in CR1. In addition, GRFS was rather superior in patients treated with DCBT. Our long-term outcome results revealed that DCBT might be a good alternative choice for patients who are not available with conventional allogeneic donors.

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Acute lymphoblastic leukemia, Graft-versus-host disease (GVHD), Hematopoietic cell transplantation, Remission

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