Effect of pediatric- versus adult-type chemotherapy regimens on outcomes of allogeneic hematopoietic stem cell transplants for adult T-cell acute lymphoblastic leukemia in first complete remission

• Published in: Bone marrow transplantation (Basingstoke) Vol. 57; no. 11; pp. 1704 - 1711
• Main Authors: Qi, Han-zhou, Xu, Jun, Yang, Qian-qian, Lin, Ren, Wang, Zhi-xiang, Zhao, Ke, Wang, Qiang, Zhou, Xuan, Fan, Zhi-ping, Huang, Fen, Xu, Na, Xuan, Li, Jin, Hua, Sun, Jing, Gale, Robert Peter, Zhou, Hong-sheng, Liu, Qi-fa
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2022; Nature Publishing Group
• Subjects: 631/67/1990/283/2125; 692/699/1541/1990/283/2125; Acute lymphoblastic leukemia; Blood; Bone marrow; Cell Biology; Chemotherapy; Confidence intervals; Disease prevention; Hematology; Hematopoietic stem cells; Infections; Internal Medicine; Leukemia; Lymphocytes T; Medical prognosis; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Patients; Pediatrics; Public Health; Remission; Remission (Medicine); Stem cell transplantation; Stem Cells; Transplantation; Transplants
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-022-01796-2

The optimal chemotherapy regimen pre-transplantation for adult T-cell acute lymphoblastic leukemia (T-ALL) patients remains unknown. Here, we compared the transplant outcomes in 127 subjects receiving pediatric- ( N  = 57) or adult-type ( N  = 70) regimens pre-transplant. The corresponding 3-year cumulative incidences of relapse (CIR) was 7% (95% CI: 3–11%) and 29% (95% CI: 23–35%; P  = 0.02), leukemia-free survivals (LFS) was 86% (95% CI: 81–91%) and 57% (95% CI: 51–63%; P  = 0.003), overall survivals (OS) was 88% (95% CI: 84–92%) and 58% (95% CI: 52–64%; P  = 0.002), the 1-year NRM was 4% (95% CI: 1–7%) and 9% (95% CI: 4–14%; P  = 0.40). Multivariate analysis showed that pediatric-type regimen was associated with lower CIR (Hazard Ratio [HR] = 0.31 [95% CI: 0.09–1.00]; P  = 0.05), better LFS (HR = 0.34 [95% CI: 0.15–0.78]; P  = 0.01) and OS (HR = 0.30 [95% CI: 0.13–0.72]; P  = 0.01). Our results suggested that adult T-ALL patients undergoing allo-HSCT might benefit from pediatric-type chemotherapy.