In a nutshell
This study aimed to compare outcomes for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) receiving chemotherapy or allogeneic hematopoietic stem cell transplantation (alloHSCT) after achieving complete remission.
This study concluded that chemotherapy led to better outcomes for these patients when compared to alloHSCT.
Some background
After achieving complete remission, patients with ALL need a consolidation therapy to kill any cancer cells that may be left in the body and prevent relapse. It can include radiation therapy, a stem cell transplant, or chemotherapy. Consolidation treatments vary if the patients are children or adults. However, AYAs represent a distinct population of patients aged 15 to 20.
Many studies encourage the use of pediatric treatments such as chemotherapy for this group of patients. However, previous studies have shown improved outcomes with alloHSCT after complete remission. AlloHSCT involves the transplant of healthy cells from a donor to replace the cells damaged during previous treatments. It first uses a strong chemotherapy that destroys the bone marrow of the patient (myeloablative; MA). This limits the risk of cancer returning. However, the optimal treatment after remission in AYAs with ALL is still not clear.
Methods & findings
This study involved AYAs with ALL in first complete remission. After remission, 263 patients received chemotherapy and 217 patients received a MA alloHSCT.
77% of the chemotherapy group and 53% of the alloHSCT group were alive after 3 years. After 5 years, 66% of the chemotherapy group and 47% of the alloHSCT group were alive. After 5 years, 58% of the chemotherapy group and 44% of the alloHSCT group were disease-free. However, the risk of relapse was higher with chemotherapy (34%) compared to alloHSCT (23%).
Patients with obesity had lower survival and higher risks of relapse.
The bottom line
This study concluded that for AYA with ALL in first remission, chemotherapy leads to better outcomes compared to MA alloHSCT.
The fine print
Patients were not randomly assigned to one treatment group. The data was based on medical records. This might limit the conclusion.
Published By :
Leukemia
Date :
Mar 30, 2021
