Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia

• Type of Material: Article
• Authors: Betty Ky Hamilton, Cleveland Clinic; Lisa Rybicki, Cleveland Clinic; Donna Abounader, Cleveland Clinic; Kehinde Adekola, Northwestern University; Anjali Advani, Cleveland Clinic; Ibrahim Aldoss, City of Hope Cancer Center; Veronika Bachanova, University of Minnesota; Asad Bashey, Northside Hospital; Stacey Brown, Northside Hospital; Marcos DeLima, University Hospitals of Cleveland; Steven Devine, Ohio State University; Christopher Flowers, Emory University
• Language: English
• Date: 2017-07
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Society for Blood and Marrow Transplantation
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2017.04.003
• Title of Journal or Parent Work: Biology of Blood and Marrow Transplantation
• ISSN: 1083-8791
• Volume: 23
• Issue: 7
• Start Page: 1117
• End Page: 1121
• Keywords: Transplantation; STANDARD-RISK; T cell; Allogeneic; Acute lymphoblastic leukemia; Life Sciences & Biomedicine; Immunology; Relapse-free survival; Hematopoietic cell transplantation; Survival; Hematology; MINIMAL RESIDUAL DISEASE; Science & Technology
• Research Categories: Biology, Cell; Health Sciences, Oncology

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with T cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission (CR) and high-risk patients in first CR. Given its relative rarity, data on outcomes of HCT for T-ALL are limited. We conducted a multicenter retrospective cohort study using data from 208 adult patients who underwent HCT between 2000 and 2014 to describe outcomes of allogeneic HCT for T-ALL in the contemporary era. The median age at HCT was 37 years, and the majority of patients underwent HCT in CR, using total body irradiation (TBI)-based myeloablative conditioning regimens. One-quarter of the patients underwent alternative donor HCT using a mismatched, umbilical cord blood, or haploidentical donor. With a median follow up of 38 months, overall survival at 5 years was 34%. The corresponding cumulative incidence of non-relapse mortality and relapse was 26% and 41%, respectively. In multivariable analysis, factors significantly associated with overall survival were the use of TBI (HR, 0.57; P = .021), age >35 years (HR, 1.55; P = .025), and disease status at HCT (HR, 1.98; P = .005 for relapsed/refractory disease compared with CR). Relapse was the most common cause of death (58% of patients). Allogeneic HCT remains a potentially curative option in selected patients with adult T-ALL, although relapse is a major cause of treatment failure.