Title :

CNS Involvement at Initial Diagnosis and Risk of Relapse After Allogeneic HCT for Acute Lymphoblastic Leukemia in First Complete Remission.

Author(s) :

Kharfan-Dabaja, M. A. [Auteur]
Labopin, Myriam [Auteur]
Centre de Recherche Saint-Antoine [CRSA]
Bazarbachi, A. [Auteur]
Salmenniemi, U. [Auteur]
Mielke, S. [Auteur]
Chevallier, Patrice [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Thérèse Rubio, Marie [Auteur]
IUT Nancy-Brabois
Balsat, Marie [Auteur]
Centre Hospitalier Lyon Sud [CHU - HCL] [CHLS]
Pioltelli, P. [Auteur]
Menard, Anne-Lise [Auteur]
Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen [CLCC Henri Becquerel]
Socié, Gérard [Auteur]
Hopital Saint-Louis [AP-HP] [AP-HP]
Huynh, Anne [Auteur]
Service Hématologie - IUCT-Oncopole [CHU Toulouse]
Schaap, N. [Auteur]
Bermúdez Rodríguez, A. [Auteur]
Cornelissen, J. J. [Auteur]
Yakoub-Agha, Ibrahim [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
Aljurf, M. [Auteur]
Giebel, S. [Auteur]
Brissot, E. [Auteur]
Peric, Z. [Auteur]
Nagler, A. [Auteur]
Mohty, M. [Auteur]

Journal title :

HemaSphere

Abbreviated title :

HEMASPHERE

Volume number :

6

Pages :

e788

Publication date :

2022-10-21

ISSN :

2572-9241

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for adult acute lymphoblastic leukemia (ALL) have improved over time. Studies have shown that total body irradiation (TBI) is the preferable type of ...
Show more >Outcomes of allogeneic hematopoietic cell transplantation (allo-HCT) for adult acute lymphoblastic leukemia (ALL) have improved over time. Studies have shown that total body irradiation (TBI) is the preferable type of myeloablative conditioning (MAC). However, outcomes based on central nervous system (CNS) involvement, namely CNS-positive versus CNS-negative, have not been compared. Here, we evaluated outcomes of 547 patients (CNS-positive = 96, CNS-negative = 451) who were allografted in the first complete remission (CR1) between 2009 and 2019. Primary endpoint was leukemia-free survival (LFS). Median follow-up was not different between the CNS-positive and CNS-negative groups (79 versus 67.2 months, P = 0.58). The CNS-positive group were younger (median age 31.3 versus 39.7 years, P = 0.004) and were allografted more recently (median year 2012 versus 2010, P = 0.003). In both groups, MAC was the preferred approach (82.3% versus 85.6%, P = 0.41). On multivariate analysis, the CNS-positive group had higher incidence of relapse (RI) (hazard ratio [HR] = 1.58 [95% confidence interval (CI) = 1.06-2.35], P = 0.025), but no adverse effect on LFS (HR = 1.38 [95% CI = 0.99-1.92], P = 0.057) or overall survival (OS) (HR = 1.28 [95% CI = 0.89-1.85], P = 0.18). A subgroup multivariate analysis limited to CNS-positive patients showed that a TBI-based MAC regimen resulted in better LFS (HR = 0.43 [95% CI = 0.22-0.83], P = 0.01) and OS (HR = 0.44 [95% CI = 0.21-0.92], P = 0.03) and lower RI (HR = 0.35 [95% CI = 0.15-0.79], P = 0.01). Another subgroup analysis in CNS-negative patients showed that MAC-TBI preparative regimens also showed a lower RI without a benefit in LFS or OS. While a MAC-TBI allo-HCT regimen may not be suitable to all, particularly for older patients with comorbidities, this approach should be considered for patients who are deemed fit and able to tolerate.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Submission date :

2024-01-12T00:20:25Z
2024-02-28T07:44:12Z