Pretransplant Consolidation Is Not Beneficial for Adults with ALL Undergoing Myeloablative Allogeneic Transplantation

• Authors: Hanna Khoury, Emory University; Nelli Bejanyan, University of Minnesota; Mei-Jie Zhang, Medical College of Wisconsin; Hai-Lin Wang, Medical College of Wisconsin; Aleksandr Lazaryan, University of Minnesota; Marcos de Lima, University Hospitals Case Medical Center; David I. Marks, University of Bristol; Brenda M. Sandmaier, University of Washington; Veronika Bachanova, University of Minnesota; Jacob Rowe, University Hospitals Cleveland Medical Center; Partow Tallman, Memorial Sloan Kettering Cancer Center; Partow Kebriaei, University of Texas; Mohamed Kharfan-Dabaja, Moffitt Cancer Center; Robert Peter Gale, Imperial College London; Hillard M. Lazarus, University Hospitals Case Medical Center; Celalettin Ustun, University of Minnesota; Edward Copelan, Levine Cancer Institute; Betty Ky Hamilton, Taussig Cancer Institute, Cleveland; Gary Schiller, David Geffen School of Medicine at UCLA; William Hogan, Mayo Clinic; Shahrukh Hashmi, Mayo Clinic; Matthew Seftel, CancerCare Manitoba; Christopher G. Kanakry, National Cancer Institute; Richard F. Olsson, Karolinska Institutet, Stockholm; Rodrigo Martino, Hospital de La Santa Creu I Sant Pau; Wael Saber, Medical College of Wisconsin; Daniel J. Weisdorf, University of Minnesota
• Journal Title: Biology of Blood and Marrow Transplantation
• Volume: Volume 24, Number 5
• Publisher: Elsevier: 12 months | 2018-05-01, Pages 945-955
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.bbmt.2017.12.784
• Subjects: Health Sciences, Oncology; Health Sciences, Pharmacology
• Keywords: ALL; Allogeneic transplant; Consolidation chemotherapy; Myeloablative conditioning; Adult; Aged; Consolidation Chemotherapy; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Middle Aged; Myeloablative Agonists; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Survival Analysis; Time Factors; Transplantation, Homologous; Treatment Outcome; Young Adult

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is curative for patients with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR1) with chemotherapy. However, the benefit of consolidation chemotherapy remains uncertain in patients undergoing alloHCT. We compared clinical outcomes of 524 adult patients with ALL in CR1 who received ≥2 (n = 109), 1 (n = 93), or 0 cycles (n = 322) of consolidation before myeloablative alloHCT from 2008 to 2012. As expected, time to alloHCT was longer with increasing cycles of consolidation. Patients receiving ≥2, 1, or 0 cycles of consolidation had an adjusted 3-year cumulative incidence of relapse of 20%, 27%, and 22%; 1-year transplant-related mortality (TRM) of 16%, 18%, and 23%; adjusted 3-year leukemia-free survival (LFS) of 54%, 48%, and 47%; and 3-year overall survival (OS) of 63%, 59%, and 54% (all P values >.40). Multivariable analysis confirmed that consolidation was not prognostic for LFS (relative risk, 1.20, 95% confidence interval,.86 to 1.67; P =.28 for no consolidation; RR, 1.18, 95% confidence interval,.79 to 1.76; P =.41 for 1 cycle versus ≥2 cycles = reference). Similarly, consolidation was not associated with OS, relapse, TRM, or graft-versus-host disease. We conclude that consolidation chemotherapy does not appear to provide added benefit in adult ALL patients with available donors who undergo myeloablative alloHCT in CR1.