Published online Nov 30, 2018. doi: 10.5500/wjt.v8.i7.252
Peer-review started: May 25, 2018
First decision: June 9, 2018
Revised: September 7, 2018
Accepted: November 3, 2018
Article in press: November 3, 2018
Published online: November 30, 2018
Processing time: 205 Days and 10.6 Hours
Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative therapy for patients with high risk acute lymphoblastic leukemia (ALL). The indications for HCT have evolved over time with the introduction of pediatric inspired protocols and minimal residual disease (MRD) monitoring. Our aim from this study is to examine the outcome and prognostic factors for high risk ALL patients at our center.
Identifying the prognostic factors that may facilitate patient selection and select the ideal candidate for transplantation.
Our aim from this study is to examine the outcome and prognostic factors for high risk ALL patients.
After due institutional review board approval, patients with high risk ALL/ lymphoblastic lymphoma (LBL) post HCT were identified and included. All records were retrospectively collected. Time to event analysis, was calculated from the date of HCT until event of interest or last follow up with KM means. Cox regression model was used for multivariable analysis calculation.
A total of 69 patients were enrolled and examined with a median age of 21 (14-61). After a median follow up of 15 mo (2-87.3), the 2-year cumulative incidence of relapse (CIR), cumulative incidence of non-relapse mortality (CI-NRM), progression free survival (PFS) and overall survival (OS) were 34.1%, 10.9%, 54.9% and 62.8%, respectively. In a multivariable analysis for OS; acute graft vs host disease (GVHD) and chronic GVHD were significant with corresponding HR 4.9 (1.99-12; P = 0.0007) and 0.29 (0.1-0.67; P = 0.0044), respectively.
Allogeneic-HCT for high risk ALL/LBL results in promising remissions and early referral for HCT is to be considered for young and fit patients.
We identified that acute and chronic graft vs host diseases were prognostic for overall survival. We also observed that patients with Philadelphia positive ALL whom were given tyrosine kinase inhibitor therapy fared better than expected. Post HCT outcome of patients with ALL is expected to improve over time with the changing therapeutic landscape. We wished to examine the outcome of ALL patients treated in a contemporary era and identify prognostic factors for outcome. Our findings warrant confirmation in a larger cohort of patients.