Pretransplant Consolidation Is Not Beneficial for Adults with ALL Undergoing Myeloablative Allogeneic Transplantation
Por:
Bejanyan, N, Zhang, MJ, Wang, HL, Lazaryan, A, de Lima, M, Marks, DI, Sandmaier, BM, Bachanova, V, Rowe, J, Tallman, M, Kebriaei, P, Kharfan-Dabaja, M, Gale, RP, Lazarus, HM, Ustun, C, Copelan, E, Hamilton, BK, Schiller, G, Hogan, W, Hashmi, S, Seftel, M, Kanakry, CG, Olsson, RF, Martino, R, Saber, W, Khoury, HJ, Weisdorf, DJ
Publicada:
1 may 2018
Resumen:
Allogeneic hematopoietic cell transplantation (alloHCT) is curative for patients with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR1) with chemotherapy. However, the benefit of consolidation chemotherapy remains uncertain in patients undergoing alloHCT. We compared clinical outcomes of 524 adult patients with ALL in CR1 who received >2 (n = 109), 1 (n = 93), or 0 cycles (n = 322) of consolidation before myeloablative alloHCT from 2008 to 2012. As expected, time to alloHCT was longer with increasing cycles of consolidation. Patients receiving 1, or 0 cycles of consolidation had an adjusted 3-year cumulative incidence of relapse of 20%, 27%, and 22%; 1-year transplant-related mortality (TRM) of 16%, 18%, and 23%; adjusted 3-year leukemia-free survival (LFS) of 54%, 48%, and 47%; and 3-year overall survival (OS) of 63%, 59%, and 54% (all P values >.40). Multivariable analysis confirmed that consolidation was not prognostic for LFS (relative risk, 1.20, 95% confidence interval,.86 to 1.67; P=.28 for no consolidation; RR, 1.18, 95% confidence interval,.79 to 1.76; P=.41 for 1 cycle versus.>:2 cycles = reference). Similarly, consolidation was not associated with OS, relapse, TRM, or graft-versus-host disease. We conclude that consolidation chemotherapy does not appear to provide added benefit in adult ALL patients with available donors who undergo myeloablative alloHCT in CR1. (C) 2017 American Society for Blood and Marrow Transplantation.
Filiaciones:
Bejanyan, N:
Univ Minnesota, Div Hematol Oncol & Transplantat, 420 Delaware St SE,Mayo Mail Code 480, Minneapolis, MN 55455 USA
Zhang, MJ:
Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA
Med Coll Wisconsin, Dept Med, CIBMTR Ctr Int Blood & Marrrow Trasnsplantat, Milwaukee, WI 53226 USA
Wang, HL:
Med Coll Wisconsin, Dept Med, CIBMTR Ctr Int Blood & Marrrow Trasnsplantat, Milwaukee, WI 53226 USA
Lazaryan, A:
Univ Minnesota, Div Hematol Oncol & Transplantat, 420 Delaware St SE,Mayo Mail Code 480, Minneapolis, MN 55455 USA
de Lima, M:
Univ Hosp Case Med Ctr, Seidman Canc Ctr, Dept Med, Cleveland, OH USA
Marks, DI:
Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England
Sandmaier, BM:
Univ Washington, Div Med Oncol, Seattle, WA 98195 USA
Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA
Bachanova, V:
Univ Minnesota, Div Hematol Oncol & Transplantat, 420 Delaware St SE,Mayo Mail Code 480, Minneapolis, MN 55455 USA
Rowe, J:
Shaare Zedek Med Ctr, Dept Hematol, Jerusalem, Israel
Tallman, M:
Mem Sloan Kettering Canc Ctr, Dept Med, Leukemia Serv, 1275 York Ave, New York, NY 10021 USA
Kebriaei, P:
Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Stem Cell Transplantat, Houston, TX 77030 USA
Kharfan-Dabaja, M:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Gale, RP:
Imperial Coll London, Div Expt Med, Dept Med, Hematol Res Ctr, London, England
Lazarus, HM:
Univ Hosp Cleveland Med Ctr, Seidman Canc Ctr, Cleveland, OH USA
Ustun, C:
Univ Minnesota, Div Hematol Oncol & Transplantat, 420 Delaware St SE,Mayo Mail Code 480, Minneapolis, MN 55455 USA
Copelan, E:
Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA
Hamilton, BK:
Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA
Schiller, G:
Univ Calif Los Angeles, David Geffen Sch Med, Hematol Malignancy Stem Cell Transplant Program, Los Angeles, CA 90095 USA
Hogan, W:
Mayo Clin Rochester, Dept Hematol, Rochester, MN USA
Mayo Clin Rochester, Transplant Ctr, Rochester, MN USA
Hashmi, S:
Mayo Clin, Dept Internal Med, Rochester, MN USA
King Faisal Specialist Hosp & Res Ctr, Ctr Oncol, Riyadh, Saudi Arabia
Seftel, M:
CancerCare Manitoba, Dept Med Oncol & Hematol, Winnipeg, MB, Canada
Kanakry, CG:
NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, NIH, Bethesda, MD 20892 USA
Olsson, RF:
Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden
Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
Martino, R:
Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain
Saber, W:
Med Coll Wisconsin, Dept Med, CIBMTR Ctr Int Blood & Marrrow Trasnsplantat, Milwaukee, WI 53226 USA
Khoury, HJ:
Emory Univ Hosp, 1364 Clifton Rd NE, Atlanta, GA 30322 USA
Weisdorf, DJ:
Univ Minnesota, Div Hematol Oncol & Transplantat, 420 Delaware St SE,Mayo Mail Code 480, Minneapolis, MN 55455 USA
Hybrid Gold, Green Accepted
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