title: Allogeneic hematopoietic cell transplantation for primary refractory acute lymphoblastic leukemia: A report from the Acute Leukemia Working Party of the EBMT.
abstract: Patients with primary refractory acute lymphoblastic leukemia (PREF ALL) who fail to achieve a complete remission (CR) after ≥2 courses of chemotherapy have a dismal prognosis without undergoing allogeneic hematopoietic cell transplantation (HCT). To the authors' knowledge, there currently are no data regarding factors influencing transplantation outcomes.
  
  
  
  The authors retrospectively studied outcomes of transplantation for cases of PREF ALL reported to European Society for Blood and Marrow Transplantation registry. Eligibility criteria for the current analysis included adult patients who underwent their first HCT for PREF ALL between 2000 and 2012. PREF disease was defined as the failure to achieve a morphological CR after ≥2 courses of induction chemotherapy.
  
  
  
  Data regarding 86 adult patients were analyzed. With a median follow-up of 106 months, the probability of survival was 36% at 2 years and 23% at 5 years. The probability of leukemia-free survival was 28% and 17%, respectively, and the probability of nonrecurrence mortality was 20% and 29%, respectively, at 2 years and 5 years. For 66 patients who achieved a CR (77%), the survival at 2 years and 5 years was 36% and 29%, respectively. In multivariate analysis, use of total body irradiation was found to be associated with improved survival. Total body irradiation and infusion of female hematopoietic cells into male recipients was associated with improved leukemia-free survival. These findings were incorporated into a scoring system that identified 3 groups (those with 2, 1, or no prognostic factors) with survival rates of 57%, 22%, and 8%, respectively.
  
  
  
  Although overall these patients would clearly benefit from the introduction of novel antileukemic therapies, the data from the current study support the use of allogeneic HCT in selected patients with PREF ALL. Cancer 2017;123:1965-1970. © 2017 American Cancer Society.
authors.affiliation: Centre for Haematology, Imperial College London at Hammersmith Hospital, London, United Kingdom.
authors.forename: Jiří
authors.initials: J
authors.lastname: Pavlů
authors.affiliation: Department of Haematology, EBMT Paris Study Office/CEREST-TC/Saint Antoine Hospital, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Department of Internal Medicine III, Hematopoietic Cell Transplantation, Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Munich, Germany.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Zoellner
authors.affiliation: Haematology-BMT Unit, George Papanicolaou General Hospital, Thessaloniki, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Sakellari
authors.affiliation: Department of Medicine A, University Hospital of Muenster, Muenster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stelljes
authors.affiliation: Hematology/Oncology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.affiliation: Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Udine University Medical Center, Udine, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.affiliation: Center for Blood Stem Cell and Bone Marrow Transplant, DKD Helios Clinic Wiesbaden, Wiesbaden, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Stuhler
authors.affiliation: First Pavlov State Medical University of Saint Petersburg, Saint Petersburg, Russia.
authors.forename: Boris V
authors.initials: BV
authors.lastname: Afanasyev
authors.affiliation: The Christie NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Bloor
authors.affiliation: Haematology-BMT Unit, George Papanicolaou General Hospital, Thessaloniki, Greece.
authors.forename: Achilles
authors.initials: A
authors.lastname: Anagnostopoulos
authors.affiliation: Department of Haematology, EBMT Paris Study Office/CEREST-TC/Saint Antoine Hospital, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Giebel
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Ramat Gan, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D017211:Treatment Failure; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: acute lymphoblastic leukemia (ALL); allogeneic transplantation; conditioning regimen; refractory disease; stem cell transplantation; total body irradiation