In a nutshell
This study aimed to investigate the impact of graft-versus-leukemia effect on survival in patients with acute lymphoblastic leukemia.
This study concluded that graft-versus-leukemia effect was beneficial in certain subsets of these patients.
Some background
Allogeneic hematopoietic stem cell transplant (allo-HSCT) is a potentially curative therapy for acute lymphoblastic leukemia (ALL). Allo-HSCT is a procedure where the patient receives blood-forming stem cells from a non-identical donor such as a sister or brother. Graft versus host disease (GVHD) can occur after allo-HSCT. It occurs when the stem cells view the body as foreign and begin to attack it. Graft versus leukemia (GVL) effect is a good response that occurs when donor cells attack leukemia cells. Portraying GVL effect as a function of GVHD may allow improved survival in ALL patients.
It is not known what impact the GVL effect has on survival in patients with ALL.
Methods & findings
This study involved 5215 patients with ALL who were treated with allo-HSCT. Patients were split into 3 groups. 2593 adult patients were in first or second complete remission (CR1/R2). 1619 pediatric patients were in CR1/CR2. 1003 patients had advanced ALL.
Patients in CR1/CR2 who developed acute GVHD (aGVHD) or chronic GVHD (cGVHD) had a 31-51% lower risk of relapse than those with no GVHD. Patients with advanced ALL developing grades III and IV aGVHD or cGVHD were at a 33-48% lower risk of relapse than those with no GVHD.
Both adult and children in CR1/CR2 with grades I and II aGVHD without cGVHD experienced the best overall survival (OS) compared to those with no GVHD. However, in all 3 groups of patients, grades III and IV aGVHD were associated with an increased risk of death. This canceled out any protection from relapse and this resulted in lower survival.
Patients with advanced ALL had a 27-31% better OS when they developed cGVHD with or without grades I and II aGVHD.
The bottom line
This study concluded that GVHD was associated with an increased GVL effect in ALL. GVL had a beneficial effect on OS only if associated with low-grade aGVHD in CR1/CR2 or with cGVHD in advanced ALL.
The fine print
This study was based on medical records of patients. Soma data was missing. This might have influenced the results.
What’s next?
If you have any concerns regarding treatment for ALL please consult with your physician.
Published By :
Blood advances
Date :
Feb 26, 2019
