Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemia.


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. Trial GRAALL-2003 was registered at as #NCT00222027; GRAALL-2005 was registered as #NCT00327678.

DOI: 10.1182/blood-2014-09-599894

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@article{Dhdin2015RoleOA, title={Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemia.}, author={Nathalie Dh{\'e}din and Anne Huynh and S{\'e}bastien Maury and Reza Sigari Tabrizi and Kheira Beldjord and Vahid Asnafi and X. Thomas and Patrice Chevallier and Stephanie Nguyen and Val{\'e}rie Coiteux and J Bourhis and Yosr Hichri and Martine Escoffre-Barbe and Oum{\'e}daly Reman and Carlos Graux and Yves Chalandon and Didier P Blaise and Urs Schanz and V{\'e}ronique Lh{\'e}ritier and Jean-Yves Y Cahn and Herv{\'e} Dombret and Norbert Ifrah}, journal={Blood}, year={2015}, volume={125 16}, pages={2486-96; quiz 2586} }