Journal
BONE MARROW TRANSPLANTATION
Volume 58, Issue 4, Pages 393-400Publisher
SPRINGERNATURE
DOI: 10.1038/s41409-022-01904-2
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For elderly patients with acute lymphoblastic leukemia (ALL) in first complete remission (CR1), autologous hematopoietic cell transplantation (auto-HCT) may be considered as an alternative to reduced intensity conditioning allogeneic HCT (RIC-allo-HCT). A retrospective study compared outcomes of RIC-allo-HCT from matched sibling donors (MSD) or matched unrelated donors (MUD) with auto-HCT for patients aged 55 years or more. While the probabilities of leukemia-free survival (LFS) and overall survival (OS) were not significantly different between RIC-allo-HCT and auto-HCT, the risk of non-relapse mortality (NRM) was higher for both MSD-HCT and MUD-HCT, and for MUD-HCT, the chance of LFS and OS was lower.
Allogeneic hematopoietic cell transplantation (allo-HCT) with reduced intensity conditioning (RIC) is an option for elderly patients with acute lymphoblastic leukemia (ALL). We retrospectively compared results of RIC-allo-HCT from either a matched sibling donor (MSD, n = 209) or matched unrelated donor (MUD, n = 209) with autologous (auto, n = 142) HCT for patients aged 55 years or more treated in first complete remission (CR1) between 2000 and 2018. The probabilities of leukemia-free survival (LFS) at 5 years were 34% for RIC-allo-HCT versus 39% for auto-HCT (p = 0.11) while overall survival (OS) rates were 42% versus 45% (p = 0.23), respectively. The incidence of relapse (RI) and non-relapse mortality (NRM) was 41% versus 51% (p = 0.22) and 25% versus 10% (p = 0.001), respectively. In a multivariate model, using auto-HCT as reference, the risk of NRM was increased for MSD-HCT (Hazard ratio [HR] = 2.1, p = 0.02) and MUD-HCT (HR = 3.08, p < 0.001), which for MUD-HCT translated into a decreased chance of LFS (HR = 1.55, p = 0.01) and OS (HR = 1.62, p = 0.008). No significant associations were found with respect to the risk of relapse. We conclude that for patients with ALL in CR1, aged above 55 years, auto-HCT may be considered a transplant option alternative to RIC-allo-HCT, although its value requires verification in prospective trials.
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