title: Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia.
abstract: Allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with T cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission (CR) and high-risk patients in first CR. Given its relative rarity, data on outcomes of HCT for T-ALL are limited. We conducted a multicenter retrospective cohort study using data from 208 adult patients who underwent HCT between 2000 and 2014 to describe outcomes of allogeneic HCT for T-ALL in the contemporary era. The median age at HCT was 37 years, and the majority of patients underwent HCT in CR, using total body irradiation (TBI)-based myeloablative conditioning regimens. One-quarter of the patients underwent alternative donor HCT using a mismatched, umbilical cord blood, or haploidentical donor. With a median follow up of 38 months, overall survival at 5 years was 34%. The corresponding cumulative incidence of non-relapse mortality and relapse was 26% and 41%, respectively. In multivariable analysis, factors significantly associated with overall survival were the use of TBI (HR, 0.57; P = .021), age >35 years (HR, 1.55; P = .025), and disease status at HCT (HR, 1.98; P = .005 for relapsed/refractory disease compared with CR). Relapse was the most common cause of death (58% of patients). Allogeneic HCT remains a potentially curative option in selected patients with adult T-ALL, although relapse is a major cause of treatment failure.
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio. Electronic address: hamiltb2@ccf.org.
authors.forename: Betty Ky
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Donna
authors.initials: D
authors.lastname: Abounader
authors.affiliation: Division of Hematology/Medical Oncology, Northwestern University, Chicago, Illinois.
authors.forename: Kehinde
authors.initials: K
authors.lastname: Adekola
authors.affiliation: Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anjali
authors.initials: A
authors.lastname: Advani
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aldoss
authors.affiliation: Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Veronika
authors.initials: V
authors.lastname: Bachanova
authors.affiliation: Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia.
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.affiliation: Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia.
authors.forename: Stacey
authors.initials: S
authors.lastname: Brown
authors.affiliation: Department of Medicine, Seidman Cancer Center, University Hospitals of Cleveland, Cleveland, Ohio.
authors.forename: Marcos
authors.initials: M
authors.lastname: DeLima
authors.affiliation: Blood and Marrow Transplant Program, Ohio State University, Columbus, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Devine
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, University of Kansas, Kansas City, Kansas.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.affiliation: Division of Hematology-Oncology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Vanessa E
authors.initials: VE
authors.lastname: Kennedy
authors.affiliation: Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dennis Dong Hwan
authors.initials: DDH
authors.lastname: Kim
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, University of Kansas, Kansas City, Kansas.
authors.forename: Joseph
authors.initials: J
authors.lastname: McGuirk
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California.
authors.forename: Vinod
authors.initials: V
authors.lastname: Pullarkat
authors.affiliation: Bone Marrow Transplant and Leukemia Program, Washington University in St Louis, St Louis, Missouri.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Romee
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California.
authors.forename: Karamjeet
authors.initials: K
authors.lastname: Sandhu
authors.affiliation: Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Melody
authors.initials: M
authors.lastname: Smith
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Masumi
authors.initials: M
authors.lastname: Ueda
authors.affiliation: Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Auro
authors.initials: A
authors.lastname: Viswabandya
authors.affiliation: Bone Marrow Transplant and Leukemia Program, Washington University in St Louis, St Louis, Missouri.
authors.forename: Khoan
authors.initials: K
authors.lastname: Vu
authors.affiliation: Blood and Marrow Transplant Program, Ohio State University, Columbus, Ohio.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wall
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia.
authors.forename: Simon B
authors.initials: SB
authors.lastname: Zeichner
authors.affiliation: Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Adult Bone Marrow Transplant Service, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D055815:Young Adult
keywords: Acute lymphoblastic leukemia; Allogeneic; Hematopoietic cell transplantation; Relapse-free survival; Survival; T cell