Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR.
Adolescent
Adult
Antineoplastic Agents
/ therapeutic use
Cohort Studies
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation
/ methods
Humans
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ drug therapy
Recurrence
Remission Induction
Transplantation Conditioning
/ methods
Transplantation, Homologous
/ methods
Young Adult
Journal
Leukemia
ISSN: 1476-5551
Titre abrégé: Leukemia
Pays: England
ID NLM: 8704895
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
17
09
2020
accepted:
25
02
2021
revised:
28
01
2021
pubmed:
1
4
2021
medline:
17
8
2021
entrez:
31
3
2021
Statut:
ppublish
Résumé
Optimal post-remission therapy for adolescents and young adults (AYAs) with Ph-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1) is not established. We compared overall survival (OS), disease-free survival (DFS), relapse, and non-relapse mortality (NRM) for patients receiving post-remission therapy on CALGB 10403 to a cohort undergoing myeloablative (MA) allogeneic hematopoietic cell transplantation (HCT) in CR1. In univariate analysis, OS was superior with chemotherapy compared to MA allogeneic HCT (3-year OS 77% vs. 53%, P < 0.001). In multivariate analysis, allogeneic HCT showed inferior OS (HR 2.00, 95% CI 1.5-2.66, P < 0.001), inferior DFS (HR 1.62, 95% CI 1.25-2.12, P < 0.001), and increased NRM (HR 5.41, 95% CI 3.23-9.06, P < 0.001) compared to chemotherapy. A higher 5-year relapse incidence was seen with chemotherapy compared to allogeneic HCT (34% vs. 23%, P = 0.011). Obesity was independently associated with inferior OS (HR 2.17, 95% CI 1.63-2.89, P < 0.001), inferior DFS (HR 1.97, 95% CI 1.51-2.57, P < 0.001), increased relapse (1.84, 95% CI 1.31-2.59, P < 0.001), and increased NRM (HR 2.10, 95% CI 1.37-3.23, P < 0.001). For AYA ALL patients in CR1, post-remission therapy with pediatric-style chemotherapy is superior to MA allogeneic HCT for OS, DFS, and NRM.
Identifiants
pubmed: 33785862
doi: 10.1038/s41375-021-01213-5
pii: 10.1038/s41375-021-01213-5
pmc: PMC8257494
mid: NIHMS1698724
doi:
Substances chimiques
Antineoplastic Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2076-2085Subventions
Organisme : NCI NIH HHS
ID : UG1 CA233290
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI126612
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180821
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL128568
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180882
Pays : United States
Organisme : NCI NIH HHS
ID : P01 CA111412
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA215134
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA152108
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI128775
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States
Organisme : NHLBI NIH HHS
ID : U24 HL138660
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069197
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA231141
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL129472
Pays : United States
Organisme : NHLBI NIH HHS
ID : OT3 HL147741
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA218285
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL130388
Pays : United States
Organisme : NIGMS NIH HHS
ID : T32 GM075766
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180888
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL131731
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126589
Pays : United States
Organisme : NCI NIH HHS
ID : UG1 CA233328
Pays : United States
Commentaires et corrections
Type : ErratumIn
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