Outcomes and Prognostic Factors for Patients with Relapsed or Refractory Acute Lymphoblastic Leukemia Who Underwent Allogeneic Hematopoietic Cell Transplantation: A KSGCT Multicenter Analysis
Year: 2020
Type: article
Study design: Observational Study
Abstract: 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 × 10 4 /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.
Authors: Takayoshi Tachibana, Junya Kanda, Takuma Ishizaki, Yuho Najima, Masatsugu Tanaka, Noriko Doki, Shin-ichiro Fujiwara, Shun-ichi Kimura, Makoto Onizuka, Satoshi Takahashi, Takeshi Saito, Takehiko Mori, Shin Fujisawa, Emiko Sakaida, Kenji Matsumoto, Nobuyuki Aotsuka, Moritaka Gotoh, Reiko Watanabe, Katsuhiro Shono, Kensuke Usuki, Nobuhiro Tsukada, Heiwa Kanamori, Yoshinobu Kanda, Shinichiro Okamoto
Institutions: Kanagawa Cancer Center, Jichi Medical University, Kyoto University, Jichi Medical University Saitama Medical Center, Saitama Medical Center, Saitama Medical University, Saitama Medical University, Gunma University, Tokyo Metropolitan Komagome Hospital, Tokai University, Tokai University Hospital, Institute of Medical Science, The University of Tokyo, The University of Tokyo, Jikei University School of Medicine, Keio University, Yokohama City University Medical Center, Chiba University Hospital, Yokohama City University, Japanese Red Cross Narita Hospital, Narita Hospital, Tokyo Medical University, Chiba Aoba Municipal Hospital, NTT Medical Center, Japanese Red Cross Medical Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2999467784