Damlaj M, Snnallah M, Alhejazi A, Ghazi S, Alahmari B, Alaskar A, Al-Zahrani M. Graft vs host disease impacts overall survival post allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia/lymphoma. World J Transplantation 2018; 8(7): 252-261 [PMID: 30596032 DOI: 10.5500/wjt.v8.i7.252]
Corresponding Author of This Article
Moussab Damlaj, FACP, FRCP (C), MD, Assistant Professor, Doctor, Division of Hematology and HCT, Department of Oncology, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia. damlajmo@ngha.med.sa
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplantation. Nov 30, 2018; 8(7): 252-261 Published online Nov 30, 2018. doi: 10.5500/wjt.v8.i7.252
Graft vs host disease impacts overall survival post allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia/lymphoma
Moussab Damlaj, Mohammad Snnallah, Ayman Alhejazi, Samer Ghazi, Bader Alahmari, Ahmed Alaskar, Mohsen Al-Zahrani
Moussab Damlaj, Mohammad Snnallah, Ayman Alhejazi, Samer Ghazi, Bader Alahmari, Ahmed Alaskar, Mohsen Al-Zahrani, Division of Hematology and HCT, Department of Oncology, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
Moussab Damlaj, Ayman Alhejazi, Ahmed Alaskar, Mohsen Al-Zahrani, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
Author contributions: Damlaj M designed the study and analyzed data; Damlaj M, Ghazi S and Snnallah M collected data; all authors provided patients, wrote and reviewed the manuscript, and approved final version of the manuscript.
Institutional review board statement: This study was approved by the institutional review board at King Abdulaziz Medical City (KAMC) - King Abdallah International Medical Research Center (KAIMRC).
Informed consent statement: The institutional review board waived informed consent due to the retrospective study design without patient contact or intervention; thus representing minimal risk study.
Conflict-of-interest statement: There are no relevant conflicts of interest relevant to the conduct of this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Moussab Damlaj, FACP, FRCP (C), MD, Assistant Professor, Doctor, Division of Hematology and HCT, Department of Oncology, King Abdulaziz Medical City, P.O. Box 22490, Riyadh 11426, Saudi Arabia. damlajmo@ngha.med.sa
Received: May 23, 2018 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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
Identifying the prognostic factors that may facilitate patient selection and select the ideal candidate for transplantation.
Research objectives
Our aim from this study is to examine the outcome and prognostic factors for high risk ALL patients.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
