Research Papers:
Allogeneic stem cell transplantation in acute lymphoblastic leukemia patients older than 60 years: a survey from the acute leukemia working party of EBMT
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Abstract
Gabrielle Roth-Guepin1,*, Jonathan Canaani2,*, Annalisa Ruggeri3, Myriam Labopin3,4,5, Juergen Finke6, Jan J. Cornelissen7, Jeremy Delage8, Gernot Stuhler9, Monserrat Rovira10, Mike Potter11, Michael Stadler12, Hendrik Veelken13, Jean Yves Cahn14, Matthew Collin15, Yves Beguin16, Sebastian Giebel17, Arnon Nagler2,3,# and Mohamad Mohty3,4,5,#
1Hematology Department, CHU Brabois, Nancy, France
2Hematology Division, Chaim Sheba Medical Center, Tel Aviv University, Tel-Aviv, Israel
3Acute Leukemia Working Party–EBMT and Department of Hematology and Cell Therapy, HÔpital Saint-Antoine, Paris, France
4INSERM UMR 938, Paris, France
5Université Pierre et Marie Curie, Paris, France
6Department of Hematology and Oncology, University Medical Center Freiburg, Freiburg, Germany
7Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands
8Service d’Hématologie et d’Oncologie, Hospital Lapeyronie CHU , University Montpellier, Montpellier, France
9Deutsche Klinik für Diagnostik, KMT Zentrum, Wiesbaden, Germany
10Hospital Clinic Barcelona, Institute of Hematology and Oncology, Department of Hematology, Barcelona, Spain
11Institute of Hematology and Oncology, Department of Hematology, London, UK
12Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Medical School, Hannover, Germany
13Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
14Department of Hematology, University Hospital, Grenoble, France
15Newcastle University, Adult HSCT unit, Northern Centre for Bone Marrow Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
16University of Liege, Department of Hematology, CHU of Liège, Liège, Belgium
17Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
*Authors share co-first authorship
#Authors share co-senior authorship
Correspondence to:
Arnon Nagler, email: [email protected]
Keywords: acute lymphoblastic leukemia; allogeneic hematopoietic cell transplantation; graft versus host disease; elderly; cytomegalovirus
Received: June 30, 2017 Accepted: November 05, 2017 Published: December 04, 2017
ABSTRACT
Hematopoietic stem cell transplantation (HSCT) is being increasingly explored as a treatment modality for older patients with acute lymphoblastic leukemia (ALL). Yet, concerns regarding the long term outcome of transplantation in older patients limit the wide spread applicability of this approach. In this analysis we set out to determine the outcome of ALL patients over the age of 60 who underwent reduced intensity HSCT. Herein, we present the experience of the acute leukemia working party (ALWP) of the EBMT in this age group. We analyzed a cohort of 142 patients transplanted in first remission with a median age of 62 (range 60–76 years) and a median follow-up period of 36 months post-transplant. At 3 years, overall survival (OS) and leukemia-free survival were 42% and 35%, respectively. Multivariate analyses identified cytomegalovirus (CMV) donor-recipient matching (CMV D+/R+) to be significantly associated with inferior OS. Patients transplanted from unrelated donors experienced increased grade II-IV acute graft versus host disease compared to those receiving grafts from matched related donors [Hazard ratio (HR) of 3.7, 95% confidence interval (CI), 1.75–7.8; p = 0.0005). Outcome was not impacted by Philadelphia chromosome status. A select subset of older ALL patients will benefit from extended survival and a disease free state following HSCT.
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