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.
Giebel
S
S
Department of Clinical and Experimental Oncology, Comprehensive Cancer Centre, Maria Sklodowska-Curie Memorial Institute Branch Gliwice, Gliwice, Poland. sgiebel@poczta.onet.pl
Stella-Holowiecka
B
B
Krawczyk-Kulis
M
M
Gökbuget
N
N
Hoelzer
D
D
Doubek
M
M
Mayer
J
J
Piatkowska-Jakubas
B
B
Skotnicki
A B
AB
Dombret
H
H
Ribera
J M
JM
Piccaluga
P P
PP
Czerw
T
T
Kyrcz-Krzemien
S
S
Holowiecki
J
J
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