Outcomes and Prognostic Factors for Patients with Relapsed or Refractory Acute Lymphoblastic Leukemia Who Underwent Allogeneic Hematopoietic Cell Transplantation: A KSGCT Multicenter Analysis

• Published in: Biology of blood and marrow transplantation Vol. 26; no. 5; pp. 998 - 1004
• Main Authors: Tachibana, Takayoshi, Kanda, Junya, Ishizaki, Takuma, Najima, Yuho, Tanaka, Masatsugu, Doki, Noriko, Fujiwara, Shin-ichiro, Kimura, Shun-ichi, Onizuka, Makoto, Takahashi, Satoshi, Saito, Takeshi, Mori, Takehiko, Fujisawa, Shin, Sakaida, Emiko, Matsumoto, Kenji, Aotsuka, Nobuyuki, Gotoh, Moritaka, Watanabe, Reiko, Shono, Katsuhiro, Usuki, Kensuke, Tsukada, Nobuhiro, Kanamori, Heiwa, Kanda, Yoshinobu, Okamoto, Shinichiro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2020
• Subjects: Acute lymphoblastic leukemia; Adolescent; Adult; Aged; Allogeneic hematopoietic cell transplantation; Hematopoietic Stem Cell Transplantation; Humans; Middle Aged; Nuclear cell count; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prognosis; Prognostic factors; Relapsed and refractory; Retrospective Studies; Scoring index; Transplantation Conditioning; Young Adult; Relapsed and refractory; Acute lymphoblastic leukemia; Nuclear cell count; Allogeneic hematopoietic cell transplantation; Prognostic factors; Scoring index
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2020.01.007

•Prognostic factors for relapsed/refractory acute lymphoblastic leukemia in allogeneic hematopoietic cell transplantation (HCT) recipients were evaluated.•Higher nuclear cell count in bone marrow is one of the independent predictors for poor survival.•The scoring may be useful in identifying patients who will receive the least benefit from HCT. A multicenter retrospective study was performed to evaluate the prognostic factors in 104 patients with relapsed or refractory acute lymphoblastic leukemia (ALL), who underwent allogeneic hematopoietic cell transplantation (HCT) between 2005 and 2015. The median age was 38 (range, 17 to 68), and the median blast fraction in peripheral blood and bone marrow was 1% (range, 0 to 99%) and 52% (range, 0 to 100%), respectively. With a median follow-up of 47 months (range, 8.3 to 105 months), overall survival (OS), nonrelapse mortality, and relapse mortality at 1 year were 25%, 44%, and 31%, respectively. Multivariate analysis demonstrated independent predictors for poor OS, including nuclear cell count in the bone marrow ≥10 × 104/μL (hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.33 to 3.43; P = .002), elevated lactate dehydrogenase level (HR, 1.66; 95% CI, 1.05 to 2.62; P = .031), and no primary induction failure (HR, 2.05; 95% CI, 1.11 to 3.78; P = .022). A prognostic scoring index was designed based on these survival predictors. At 2 years, OS was 28%, 14%, and 0% for good (score 0 or 1; n = 47), intermediate (score 2; n = 40), and poor (score 3; n = 17), respectively (P < .001). This scoring system may be useful in identifying the patient population for which allogeneic HCT is least beneficial in advanced stages of ALL.