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Faster Lymphocyte Recovery After Allogeneic Hematopoietic Cell Transplantation (HCT) Predicts For Decreased Non-Relapse Mortality (NRM) In Adults With Acute Lymphoblastic Leukemia (ALL)

Year: 2010

Type: article

Abstract: Allogeneic HCT remains an effective means of long-term disease control in adult ALL, but high NRM with HCT in these heavily pre-treated patients (pts) limits overall survival (OS). We looked at predictors for NRM and OS in pts who had received allogeneic HCT for intermediate or high risk ALL from 2005 through 2009 at MD Anderson Cancer Center. 65 pts with median age 32 years (range 18-62) with ALL in remission (CR1=29, CR2=19, greater than CR2=5) or relapse (n=5) were identified. Pts received a matched related (n=37) or matched unrelated (n=28) peripheral blood (n=50) or bone marrow (n=15) T-cell replete transplant following myeloablative conditioning (Busulfan130 mg/m2×4/Melphalan70 mg/m2×2, n=42; TBI12 Gy/Etoposide 60 mg/kg n=23). All patients received tacrolimus and mini-dose methotrexate for GVHD prophylaxis; unrelated donors additionally received anti-thymocyte globulin. OS and NRM rates at 2 years were 47% and 32%, respectively, with median follow-up after HCT of 18 months. Age, disease stage at time of HCT, cytogenetic risk, donor type, cell source, conditioning regimen, and absolute lymphocyte count on day 21 (D21ALC) and day 30 (D30ALC) post HCT were evaluated in a univariate analysis with regards to impact on NRM and OS using the Cox proportional hazards model. All outcomes were estimated in landmark analysis starting on day 21 or day 30 as indicated by ALC. Age >45 years was associated with increased NRM and worse outcome (HR 4.5, 95%CI 1.1-11.7, p=0.002 for NRM; HR 2.3, 95% CI 1.1-4.9, p=0.02 for OS). Early disease (CR1 or CR 2 vs advanced disease) was associated with decreased NRM and better outcome (HR 0.4, 95% CI 0.1-0.9, p=0.04 for NRM; HR 0.3, 95%CI 0.2-0.7, p=0.003 for OS). Median D21ALC was 300/uL. D21ALC >300/uL was associated with decreased NRM and better outcome (HR 0.4, 95%CI 0.1-0.9, p=0.035 for NRM; HR 0.6, 95%CI 0.3-1.2, p=0.1 for OS). D30ALC greater than median level 650/uL was not associated with better outcome. When analyzed by donor type, faster ALC recovery was significantly associated with better outcome in unrelated HCT vs related HCT (p=.035 vs. p=0.2). Further, no association was noted between ALC recovery and disease stage or age. Small sample size prohibited multivariate analysis. An association between ALC recovery and HCT outcome has been previously reported for adult ALL, although this is the first report for such an association following matched unrelated HCT. A larger study is needed to confirm these findings.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2009.12.380