Reduced intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia

Ashley E. Rosko, Hai Lin Wang, Marcos de Lima, Brenda Sandmaier, H. Jean Khoury, Andrew Artz, Johnathan Brammer, Christopher Bredeson, Sherif Farag, Mohamed Kharfan-Dabaja, Hillard M. Lazarus, David I. Marks, Rodrigo Martino Bufarull, Joseph McGuirk, Mohamed Mohty, Taiga Nishihori, Ian Nivison-Smith, Armin Rashidi, Olle Ringden, Matthew SeftelDaniel Weisdorf, Veronika Bachanova, Wael Saber

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Older adults with B-cell acute lymphoblastic leukemia (B-ALL) have poor survival. We examined the effectiveness of reduced intensity conditioning (RIC) hematopoietic cell transplant (HCT) in adults with B-ALL age 55 years and older and explored prognostic factors associated with long-term outcomes. Using CIBMTR registry data, we evaluated 273 patients (median age 61, range 55–72) with B-ALL with disease status in CR1 (71%), >CR2 (17%) and Primary Induction Failure (PIF)/Relapse (11%), who underwent RIC HCT between 2001 and 2012 using mostly unrelated donor (59%) or HLA-matched sibling (32%). Among patients with available cytogenetic data, the Philadelphia chromosome (Ph+) was present in 50%. The 3-year cumulative incidences of nonrelapse mortality (NRM) and relapse were 25% (95% confidence intervals (CI): 20–31%) and 47% (95% CI: 41–53%), respectively. Three-year overall survival (OS) was 38% (95% CI: 33–44%). Relapse remained the leading cause of death accounting for 49% of all deaths. In univariate analysis, 3 year risk of NRM was significantly higher with reduced Karnofsky performance status (KPS <90: 34% (95% CI: 25–43%) versus KPS ≥90 (18%; 95% CI: 12–24%, P = 0.006). Mortality was increased in older adults (66+ vs. 55–60: Relative Risk [RR] 1.51 95% CI: 1.00–2.29, P = 0.05) and those with advanced disease (RR 2.13; 95% CI: 1.36–3.34, P = 0.001). Survival of patients in CR1 yields 45% (95% CI: 38–52%) at 3 years and no relapse occurred after 2 years. We report promising OS and acceptable NRM using RIC HCT in older patients with B-ALL. Disease status in CR1 and good performance status are associated with improved outcomes. Am. J. Hematol. 92:42–49, 2017.

Original languageEnglish (US)
Pages (from-to)42-49
Number of pages8
JournalAmerican Journal of Hematology
Volume92
Issue number1
DOIs
StatePublished - Jan 1 2017

ASJC Scopus subject areas

  • Hematology

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    Rosko, A. E., Wang, H. L., de Lima, M., Sandmaier, B., Khoury, H. J., Artz, A., Brammer, J., Bredeson, C., Farag, S., Kharfan-Dabaja, M., Lazarus, H. M., Marks, D. I., Martino Bufarull, R., McGuirk, J., Mohty, M., Nishihori, T., Nivison-Smith, I., Rashidi, A., Ringden, O., ... Saber, W. (2017). Reduced intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia. American Journal of Hematology, 92(1), 42-49. https://doi.org/10.1002/ajh.24575