Improvements in allogeneic hematopoietic cell transplantation outcomes for adults with ALL over the past 3 decades

• Published in: Blood advances Vol. 6; no. 15; pp. 4558 - 4569
• Main Authors: Nishiwaki, Satoshi, Akahoshi, Yu, Morita-Fujita, Mari, Shimizu, Hiroaki, Uchida, Naoyuki, Ozawa, Yukiyasu, Fukuda, Takahiro, Tanaka, Masatsugu, Ikegame, Kazuhiro, Ota, Shuichi, Katayama, Yuta, Takahashi, Satoshi, Kawakita, Toshiro, Ara, Takahide, Onizuka, Makoto, Kimura, Takafumi, Tanaka, Junji, Atsuta, Yoshiko, Arai, Yasuyuki
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 09.08.2022; The American Society of Hematology
• Subjects: Transplantation
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2022008032

Allogeneic hematopoietic cell transplantation (allo-HCT) is a promising treatment for adult acute lymphoblastic leukemia (ALL), an intractable hematological malignancy. The trends in allo-HCT outcomes over the past 30 years were examined to verify the efficacy of evolving treatment methods and to identify further challenges. We analyzed data from a registry database that included 8467 adult ALL patients who underwent their first allo-HCT between 1990 and 2019. The period was divided into three 10-year intervals for analysis. Five-year overall survival improved from 48.2% to 70.2% in the first complete remission (CR1), from 25.6% to 44.1% in subsequent CR, and from 10.0% to 22.7% in non-CR. Nonrelapse mortality improved over the 3 decades in each disease stage. However, the relapse rate only improved in CR1 every decade (26.3% to 15.9% in CR1, 33.4% to 32.8% in subsequent CR, and 53.6% to 54.8% in non-CR). Although there were continual improvements in adjusted survival for Philadelphia chromosome (Ph)-positive patients, the improvement was inadequate for Ph− patients with t(4;11), t(8;14), t(14;18), or hypodiploidy. Allo-HCT outcomes for adults with ALL have improved over the past 30 years. Improved outcomes in the future will require more effective prevention of relapse in patients with ALL not in CR1 and in those with high-risk chromosomal abnormalities. •Outcomes of allo-HCT for ALL improved over 30 years, with an overall decrease in nonrelapse mortality and a decline in relapse among CR1.•Although the survival of Ph+ patients steadily improved, improvements for high-risk non-Ph patients were inadequate. [Display omitted]