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Allogeneic transplantation is not superior to chemotherapy in most patients over 40 years of age with Philadelphia-negative acute lymphoblastic leukemia in first remission

2016; Wiley; Volume: 91; Issue: 8 Linguagem: Inglês

10.1002/ajh.24410

1096-8652

Ofir Wolach, Kristen E. Stevenson, Martha Wadleigh, Daniel J. DeAngelo, David P. Steensma, Karen K. Ballen, Robert J. Soiffer, Joseph H. Antin, Donna Neuberg, Vincent T. Ho, Richard M. Stone,

Acute Myeloid Leukemia Research

Survival of patients ≥40 years of age with Philadelphia‐negative acute lymphoblastic leukemia (ALL) remains poor with current therapeutic approaches. It is unknown whether allogeneic hematopoietic stem‐cell transplantation (HSCT) in first remission confers a survival benefit compared to a chemotherapy‐only approach. We retrospectively compared the outcome of patients >40 years treated with HSCT or chemotherapy alone in first remission ( n = 40 in each cohort). Three‐year overall survival (OS) and disease‐free survival (DFS) were not significantly different between the chemotherapy‐only and HSCT groups (OS, 46% [31–68] vs. 40% [27–59], P = 0.35; DFS, 31% [18–52] vs. 40% [27–59], P = 0.98). The 3‐year cumulative incidence of relapse (CIR) and non‐relapse mortality (NRM) were 61% [41–76] and 9% [2–21] for the chemotherapy‐only group and 28% [15–43] and 32% [17–47] for the transplant group (CIR, P = 0.011; NRM, P = 0.014). Allogeneic transplantation for patients ≥40 years with Ph‐negative ALL in first remission is associated with a lower CIR, but this benefit is offset by considerable NRM as compared with chemotherapy‐only approach. HSCT may be beneficial in patients with high‐risk disease features. Am. J. Hematol. 91:793–799, 2016. © 2016 Wiley Periodicals, Inc.