Outcome after first relapse post‐immunochemotherapy in older adults with Philadelphia‐negative B‐cell acute lymphoblastic leukemia: A GRAALL study

BACKGROUND: Inotuzumab (InO)-based frontline regimens have significantly improved the survival of older patients with Philadelphia-negative (Ph-) B-cell acute lymphoblastic leukemia (B-ALL). Yet, outcome after relapse is not reported for this population. METHODS: The retrospective RELAPSINO study describes post-relapse outcome of 48 older patients treated front-line with a combination of InO and low-dose chemotherapy in the EWALL-INO trial (NCT03249870). At relapse (91% medullary), median age was 70 years and median duration of first complete remission (CR1) 15.2 months. CD19 or CD22 expression loss was observed in respectively 13% and 23% of evaluable cases. Most patients (85%) received salvage therapy (blinatumomab, low dose or intensive chemotherapy, in combination or not). There was no InO re-treatment. RESULTS: Overall, CR2 was reached by 51% of the patients. Median event-free survivals (EFS, 3.2 months) and overall survivals (OS, 4.5 months) were dismal. For patients achieving CR2, 2-year OS was 46% and leukemia-free survival (LFS) was 36%. By multivariable analysis, not receiving intensive chemotherapy was associated with significantly lower EFS (hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.43-7.53, p = .005), LFS (HR, 13.2; 95% CI, 2.46-70.88, p = .003), and OS (HR, 3.25; 95% CI, 1.39-7.59, p = .006). CR1 duration ≥12 months was significantly associated with better EFS (HR, 0.31; 95% CI, 0.14-0.67, p = .003), LFS (HR, 0.16; 95% CI, 0.04-0.72, p = .01), and OS (HR, 0.42; 95% CI, 0.20-0.89, p = .023). Not achieving CR2 was associated with lower OS (HR, 8.0; 95% CI, 3.25-20.1, p < .001). Receiving blinatumomab had no impact. CONCLUSIONS: These results indicate that salvage regimen should be proposed in this context, allowing 50% of patients to achieve CR2 and have better survival.

Authors

Institutions

Publication Details

Journal
Cancer
Published
2026-09-24
DOI
https://doi.org/10.1002/cncr.70621
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
article

Outcome after first relapse post‐immunochemotherapy in older adults with Philadelphia‐negative B‐cell acute lymphoblastic leukemia: A GRAALL study

Françoise Huguet, Emmanuel Rafoux, Pascal Turlure, Jean Bastié et al.
Cancer
Acute Lymphoblastic Leukemia research
article

Outcome after first relapse post‐immunochemotherapy in older adults with Philadelphia‐negative B‐cell acute lymphoblastic leukemia: A GRAALL study

Françoise Huguet, Emmanuel Rafoux, Pascal Turlure, Jean Bastié, Maxime Jullien, Stefan Wickenhauser, Patrice Chevallier, Thibaut Leguay, Delphine Lebon, Amine Belhabri, Yosr Hicheri, Gabrielle Roth-Guépin, Victoria Cacheux, Thomas Cluzeau, Ana Berceanu, Karin Bilger, Anne Banos, Perrine Moyer, Sarah Bonnet, Emmanuelle Tavernier, Hervé Dombret, Eolia Brissot, Philippe Rousselot, Marie Balsat, Magda Alexis, Stéphane Leprêtre, Nicolas Boissel
article en

Abstract

BACKGROUND: Inotuzumab (InO)-based frontline regimens have significantly improved the survival of older patients with Philadelphia-negative (Ph-) B-cell acute lymphoblastic leukemia (B-ALL). Yet, outcome after relapse is not reported for this population. METHODS: The retrospective RELAPSINO study describes post-relapse outcome of 48 older patients treated front-line with a combination of InO and low-dose chemotherapy in the EWALL-INO trial (NCT03249870). At relapse (91% medullary), median age was 70 years and median duration of first complete remission (CR1) 15.2 months. CD19 or CD22 expression loss was observed in respectively 13% and 23% of evaluable cases. Most patients (85%) received salvage therapy (blinatumomab, low dose or intensive chemotherapy, in combination or not). There was no InO re-treatment. RESULTS: Overall, CR2 was reached by 51% of the patients. Median event-free survivals (EFS, 3.2 months) and overall survivals (OS, 4.5 months) were dismal. For patients achieving CR2, 2-year OS was 46% and leukemia-free survival (LFS) was 36%. By multivariable analysis, not receiving intensive chemotherapy was associated with significantly lower EFS (hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.43-7.53, p = .005), LFS (HR, 13.2; 95% CI, 2.46-70.88, p = .003), and OS (HR, 3.25; 95% CI, 1.39-7.59, p = .006). CR1 duration ≥12 months was significantly associated with better EFS (HR, 0.31; 95% CI, 0.14-0.67, p = .003), LFS (HR, 0.16; 95% CI, 0.04-0.72, p = .01), and OS (HR, 0.42; 95% CI, 0.20-0.89, p = .023). Not achieving CR2 was associated with lower OS (HR, 8.0; 95% CI, 3.25-20.1, p < .001). Receiving blinatumomab had no impact. CONCLUSIONS: These results indicate that salvage regimen should be proposed in this context, allowing 50% of patients to achieve CR2 and have better survival.

CancerVol. 132(19)
Université de Bordeaux (FR), Lyon College (US), Université de Montpellier (FR), Université Côte d'Azur (FR), Centre Hospitalier Universitaire de Nice (FR), Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (FR), Centre Hospitalier Universitaire de Montpellier (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Assistance Publique – Hôpitaux de Paris (FR), Institut universitaire du cancer de Toulouse Oncopole (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hospices Civils de Lyon (FR), Hôpital Saint-Antoine (FR), University of Clermont Auvergne (FR), Centre Léon Bérard (FR), Centre Hospitalier Universitaire de Reims (FR), Centre Hospitalier de la Côte Basque (FR), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Laboratoire National Henri Becquerel (FR), Maison des Sciences sociales et des Humanités de Dijon (FR), Hôpital Saint-Louis (FR), Centre hospitalier universitaire d'Orléans (FR), Institut Paoli-Calmettes (FR), Centre Hospitalier Universitaire de Saint-Étienne (FR), Centre Hospitalier de Versailles (FR), Hôpital Civil, Strasbourg (FR), Institut Lavoisier de Versailles (FR), Université de Limoges (FR), Université de Nîmes (FR), Université de Strasbourg (FR), Université de Reims Champagne-Ardenne (FR)
Good health and well-being
Openalex Percentile: Top 9%
Acute Lymphoblastic Leukemia research
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.