Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemia
Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemia
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DOI：
10.1182/blood-2014-09-599894
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发表时间：
2015-04-16
期刊：
影响因子：
20.3
通讯作者：
Ifrah, Norbert
中科院分区：
文献类型：
--
作者：
Dhedin, Nathalie;Huynh, Anne;Ifrah, Norbert
由于一个受儿科启发的成人急性淋巴母细胞性白血病研究小组(GRAALL)方案在费城染色体阴性的成人ALL患者中产生了显著改善的结果，我们的目标是重新评估在GRAALL-2003和GRAALL-2005试验中治疗的患者中异基因干细胞移植(SCT)的作用。总共有522名年龄在15岁到55岁之间且至少有1个常规高危因素的患者是首次完全缓解时接受SCT的候选患者。其中，282人(54%)在首次完全缓解时接受了移植。移植后3年的累积复发率为19.5%，无复发死亡率为15.5%，无复发生存率(RFS)为64.7%。时间依赖分析没有发现SCT组和非SCT组的RFS有显著差异。然而，在诱导后微小残留病(MRD)和GT；=10(-3)(风险比，0.40)的患者中，SCT与较长的RFS相关，而在MRD反应良好的患者中则不相关。在B细胞前体ALL中，SCT也使局部IKZF1基因缺失的患者受益(危险比，0.42)。这篇文章表明，与传统的ALL危险因素相比，早期MRD反应差是在强化成人ALL治疗的背景下识别可能从同种异体SCT中受益的患者的极好工具。
Because a pediatric-inspired Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL) protocol yielded a markedly improved outcome in adults with Philadelphia chromosome-negative ALL, we aimed to reassess the role of allogeneic stem cell transplantation (SCT) in patients treated in the GRAALL-2003 and GRAALL-2005 trials. In all, 522 patients age 15 to 55 years old and presenting with at least 1 conventional high-risk factor were candidates for SCT in first complete remission. Among these, 282 (54%) received a transplant in first complete remission. At 3 years, posttransplant cumulative incidences of relapse, nonrelapse mortality, and relapse-free survival (RFS) were estimated at 19.5%, 15.5%, and 64.7%, respectively. Time-dependent analysis did not reveal a significant difference in RFS between SCT and no-SCT cohorts. However, SCT was associated with longer RFS in patients with postinduction minimal residual disease (MRD) >= 10(-3) (hazard ratio, 0.40) but not in good MRD responders. In B-cell precursor ALL, SCT also benefitted patients with focal IKZF1 gene deletion (hazard ratio, 0.42). This article shows that poor early MRD response, in contrast to conventional ALL risk factors, is an excellent tool to identify patients who may benefit from allogeneic SCT in the context of intensified adult ALL therapy.