Status of minimal residual disease determines outcome of autologous hematopoietic SCT in adult ALL.
The role of autologous hematopoietic SCT (autoHSCT) in the treatment of high-risk (HR) adult ALL is controversial. In this study, we retrospectively analyzed the results of autoHSCT according to the status of minimal residual disease (MRD) at transplantation, as a joint analysis of the European Study Group for Adult ALL (EWALL). Data on 123 recipients of autoHSCT, aged 31 (16-59) years, with B-lineage (n=77) or T-lineage (n=46) ALL were included. In a cohort of Ph-negative ALL, the probability of leukemia-free survival at 5 years was higher for patients with MRD <0.1% compared with those with MRD > or = 0.1% (57 vs 17%, P=0.0002). The difference was significant for T-lineage ALL (62 vs 8%, P=0.001), and a tendency was observed for B-lineage ALL (54 vs 26%, P=0.17). In a multivariate analysis, adjusted for other potential prognostic factors, high MRD level remained the only independent factor associated with increased risk of failure (risk ratio, 2.8; P=0.0005). We conclude that MRD determines the outcome of autoHSCT in HR adult ALL. Our results suggest the need to reevaluate the role of this treatment option in prospective trials.
Department of Clinical and Experimental Oncology, Comprehensive Cancer Centre, Maria Sklodowska-Curie Memorial Institute Branch Gliwice, Gliwice, Poland. sgiebel@poczta.onet.pl
S
S
Giebel
B
B
Stella-Holowiecka
M
M
Krawczyk-Kulis
N
N
Gökbuget
D
D
Hoelzer
M
M
Doubek
J
J
Mayer
B
B
Piatkowska-Jakubas
A B
AB
Skotnicki
H
H
Dombret
J M
JM
Ribera
P P
PP
Piccaluga
T
T
Czerw
S
S
Kyrcz-Krzemien
J
J
Holowiecki
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult