Abstract:
: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 www.clinicaltrials.gov as #NCT00222027; GRAALL-2005 was registered as #NCT00327678.
journal_name
Bloodjournal_title
Bloodauthors
Dhédin N,Huynh A,Maury S,Tabrizi R,Beldjord K,Asnafi V,Thomas X,Chevallier P,Nguyen S,Coiteux V,Bourhis JH,Hichri Y,Escoffre-Barbe M,Reman O,Graux C,Chalandon Y,Blaise D,Schanz U,Lhéritier V,Cahn JY,Dombret H,Ifdoi
10.1182/blood-2014-09-599894subject
Has Abstractpub_date
2015-04-16 00:00:00pages
2486-96; quiz 2586issue
16eissn
0006-4971issn
1528-0020pii
blood-2014-09-599894journal_volume
125pub_type
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