Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings

The optimal myeloablative conditioning regimen for ALL patients undergoing hematopoietic cell transplant (HCT) with an alternative donor is unknown. We analyzed HCT outcomes ALL patients (n = 269) who underwent HCT at our center from 2010 to 2020 in complete remission (CR) after FTBI-etoposide and CNI-based GvHD prophylaxis for matched donor HCT (ETOP-package; n = 196) or FTBI-Fludarabine and post-transplant cyclophosphamide (PTCy)-based prophylaxis for HLA- mismatched (related or unrelated) donors (FLU-package; n = 64). Patients in FLU-package showed a significant delay in engraftment (p < 0.001) and lower cumulative incidence (CI) of any and extensive chronic GVHD (p = 0.009 and 0.001, respectively). At the median follow up of 4.6 years (range 1-12 years); non-relapse mortality, overall or leukemia-free survival and GVHD-free/relapse-free survival were not significantly impacted by the choice of conditioning. However, in patients at CR2 or with measurable residual disease (MRD+), there was a trend towards higher relapse after FLU-package (p = 0.08 and p = 0.07, respectively), while patients at CR1 regardless of MRD status had similar outcomes despite the package/donor type (p = 0.9 and 0.7, respectively). Our data suggests that FLU-package for alternative donors offers comparable outcomes to ETOP-package for matched donor HCT to treat ALL. Disease status and depth of remission at HCT were independent predictors for better outcomes.

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Publication Details

Journal
Bone Marrow Transplantation
Published
2024-08-15
DOI
https://doi.org/10.1038/s41409-024-02378-0
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
0.00

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article

Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings

Eileen Smith, Vaibhav Agrawal, Anthony S. Stein, Vinod A. Pullarkat et al.
Bone Marrow Transplantation
Acute Lymphoblastic Leukemia research
article

Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings

Eileen Smith, Vaibhav Agrawal, Anthony S. Stein, Vinod A. Pullarkat, Sally Mokhtari, Amanda Blackmon, Ahmed Aribi, Stephen J. Forman, Ibrahim Taha Aldoss, Monzr M. Al Malki, Pamela S. Becker, Shukaib Arslan, Andrew Artz, Brian Ball, Guido Marcucci, Peter Curtin, Karamjeet Sandhu, Amandeep Salhotra, Paul Koller, Haris Ali, Hoda Pourhassan, Forrest Stewart, Salman Otoukesh, Idoroenyi Amanam, Ryotaro Nakamura, Dongyun Yang
article en

Abstract

The optimal myeloablative conditioning regimen for ALL patients undergoing hematopoietic cell transplant (HCT) with an alternative donor is unknown. We analyzed HCT outcomes ALL patients (n = 269) who underwent HCT at our center from 2010 to 2020 in complete remission (CR) after FTBI-etoposide and CNI-based GvHD prophylaxis for matched donor HCT (ETOP-package; n = 196) or FTBI-Fludarabine and post-transplant cyclophosphamide (PTCy)-based prophylaxis for HLA- mismatched (related or unrelated) donors (FLU-package; n = 64). Patients in FLU-package showed a significant delay in engraftment (p < 0.001) and lower cumulative incidence (CI) of any and extensive chronic GVHD (p = 0.009 and 0.001, respectively). At the median follow up of 4.6 years (range 1-12 years); non-relapse mortality, overall or leukemia-free survival and GVHD-free/relapse-free survival were not significantly impacted by the choice of conditioning. However, in patients at CR2 or with measurable residual disease (MRD+), there was a trend towards higher relapse after FLU-package (p = 0.08 and p = 0.07, respectively), while patients at CR1 regardless of MRD status had similar outcomes despite the package/donor type (p = 0.9 and 0.7, respectively). Our data suggests that FLU-package for alternative donors offers comparable outcomes to ETOP-package for matched donor HCT to treat ALL. Disease status and depth of remission at HCT were independent predictors for better outcomes.

Bone Marrow TransplantationVol. 59(11)
City Of Hope National Medical Center (US)
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health
Good health and well-being
Openalex Percentile: Top 80%
Acute Lymphoblastic Leukemia research
DOIOpen Access PDFOpenAlex
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