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Posted by on Apr 9, 2017 in Leukemia | 0 comments

In a nutshell

This study examined the role of stem cell transplantation in adult acute lymphoblastic leukemia (ALL) patients treated with pediatric-inspired chemotherapy. The study also explored whether minimal residual disease could help to predict which patients would benefit from stem cell transplant. Researchers reported that early minimal residual disease response was the best predictor of who would benefit from stem cell transplantation.

Some background

ALL is a type of cancer in which the bone marrow makes too many lymphoblasts (a type of early white blood cell). This type of cancer usually gets worse quickly if it is not treated. Chemotherapy is often the first-line treatment for ALL. It lowers the number of normal blood-forming cells in the bone marrow, and can be very toxic to the bone marrow. Without the stem cells (immature cells) in the bone marrow, new red or white blood cells cannot be produced. Healthy stem cells must be reintroduced (transplanted) following treatment. Stem cell transplantation is considered the most effective therapy for ALL patients who have achieved complete remission (no sign of disease) after treatment.

Using treatments similar to those used for children have improved results in adult patients (up to age 60). It may be possible to avoid stem cell transplantation in some of these patients.

Minimal residual disease (MRD) is the name given to small numbers of leukemia cancer cells that remain in the patient during treatment, or after treatment when the patient is in remission. It is often used as a measure to predict outcomes of first-line therapy. It may also be a predictor of stem cell transplantation success. However, more studies are needed. Finding predictors of treatment success can help in identifying patients that may significantly benefit from a stem cell transplant.

Methods & findings

The aim of this study was to examine factors that affect stem cell transplant outcomes in ALL patients.

The records of 522 patients with high-risk ALL were analyzed. All patients were in complete remission after primary therapy and were candidates for a stem cell transplant. 54% of patients for who a donor was found received a transplant from that donor while in first complete remission. The average time between first remission and transplant was 106 days. Patients were followed for an average of 3.5 years after the transplant.

Of the 282 patients who underwent a transplant, 53 relapsed and 89 died. 46 deaths occurred during first remission. At 3 years, 19.5% of patients experienced a disease relapse. 15.5% died without a documented relapse during the same period. 64.7% of patients were relapse-free 3 years after the transplant. The 3-year overall survival rate (proportion who have not died from any cause since treatment) was 69.5%.

No significant differences in survival were observed between different types of ALL (such as T-precursor and B-precursor ALL). After accounting for the type of stem cell donor, being 45 years or older increased the risk of mortality 1.9-fold. Mortality risk was doubled for patients with more than 3 cycles of treatment before the transplant. However, these factors were not associated with an increased risk of relapse.

Of the 240 patients who did not undergo a stem cell transplant, 107 relapsed and 107 died. 21 of the deaths occurred during first remission. Relapse-free survival and overall survival were not significantly worse among patients not treated with a transplant. Age or the type of ALL did also not affect clinical outcomes.

A stem cell transplant significantly improved relapse-free survival among those patients with low MRD after primary therapy. For poor MRD responders, the chance of being alive and relapse-free at 3 years was 63% lower. Overall survival was 59% lower. In contrast, relapse-free survival was 38% higher and overall survival 47% higher among good MRD responders. This analysis accounted for certain genetic differences as well as age.

The bottom line

Researchers concluded that poor early MRD response is an effective tool to help identify patients who may benefit from a stem cell transplant.

The fine print

Larger studies are needed to confirm the predictive power or early MRD response.

Published By :

Blood

Date :

Apr 16, 2015

Original Title :

Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemia.

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