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

Bejanyan N, Zhang MJ, Wang HL, Lazaryan A, de Lima M, Marks DI, Sandmaier BM, Bachanova V, Rowe J, Tallman M, Kebriaei P, Kharfan-Dabaja M, Peter Gale R, Lazarus HM, Ustun C, Copelan E, Ky Hamilton B, Schiller G, Hogan W, Hashmi S, Seftel M, Kanakry CG, Olsson RF, Martino R, Saber W, Khoury HJ, Weisdorf DJ

Biol Blood Marrow Transplant 24 (5) 945-955 [2018-05-00; online 2017-12-21]

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.

PubMed 29275139

DOI 10.1016/j.bbmt.2017.12.784

Crossref 10.1016/j.bbmt.2017.12.784

mid: NIHMS941192
pmc: PMC5953798
pii: S1083-8791(17)31710-X