Chemotherapy or allogeneic transplantation in high-risk Philadelphia chromosome-negative adult lymphoblastic leukemia
Por:
Ribera JM, Morgades M, Ciudad J, Montesinos P, Esteve J, Genesca E, Barba P, Ribera J, García Cadenas I, Moreno MJ, Martínez-Carballeira D, Torrent A, Martínez-Sánchez P, Monsalvo S, Gil C, Tormo M, Artola MT, Cervera M, González-Campos J, Rodríguez-Medina C, Bermúdez A, Novo A, Soria B, Coll R, Amigo ML, López A, Fernández Martín R, Serrano J, Mercadal S, Cladera A, Giménez-Conca AD, Peñarrubia MJ, Abella E, Vall-Llovera F, Hernández-Rivas JM, Garcia A, Bergua Burgues JM, de Rueda B, Sánchez-Sánchez MJ, Serrano A, Calbacho M, Alonso Vence N, Méndez-Sánchez JÁ, García-Boyero R, Olivares M, Barrena S, Zamora L, Granada I, Lhermitte L, Feliu E and Orfao A
Publicada:
8 abr 2021
Ahead of Print:
4 nov 2020
Resumen:
The need for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adults with Philadelphia chromosome-negative (Ph-) acute lymphoblastic leukemia (ALL) with high-risk (HR) features and adequate measurable residual disease (MRD) clearance remains unclear. The aim of the ALL-HR-11 trial was to evaluate the outcomes of HR Ph- adult ALL patients following chemotherapy or allo-HSCT administered based on end-induction and consolidation MRD levels. Patients aged 15 to 60 years with HR-ALL in complete response (CR) and MRD levels (centrally assessed by 8-color flow cytometry) <0.1% after induction and <0.01% after early consolidation were assigned to receive delayed consolidation and maintenance therapy up to 2 years in CR. The remaining patients were allocated to allo-HSCT. CR was attained in 315/348 patients (91%), with MRD <0.1% after induction in 220/289 patients (76%). By intention-to-treat, 218 patients were assigned to chemotherapy and 106 to allo-HSCT. The 5-year (+/- 95% confidence interval) cumulative incidence of relapse (CIR), overall survival (OS), and event-free survival probabilities for the whole series were 43% +/- 7%, 49% +/- 7%, and 40% +/- 6%, respectively, with CIR and OS rates of 45% +/- 8% and 59% +/- 9% for patients assigned to chemotherapy and of 40% +/- 12% and 38% +/- 11% for those assigned to allo-HSCT, respectively. Our results show that avoiding allo-HSCT does not hamper the outcomes of HR Ph- adult ALL patients up to 60 years with adequate MRD response after induction and consolidation. Better postremission alternative therapies are especially needed for patients with poor MRD clearance.
Filiaciones:
Ribera JM:
Institut Català d'Oncologia-Hospital Germans Trias i Pujol. Josep Carreras Research Institute. Badalona. Universitat Autònoma de Barcelona, Badalona, Spain
Morgades M:
ICO-Hospital Germans Trias i Pujol, Badalona, Spain
Ciudad J:
IBSAL, IBMCC, Centro de Investigación del Cáncer, CIBERONC, Universidad de Salamanca-CSIC, Hospital Universitario de Salamanca, Salamanca, Spain
Montesinos P:
Hospital Universitari I Politècnic La Fe, Valencia, Spain
Esteve J:
IDIBAPS, Hospital Clinic
Genesca E:
Josep Carreras Leukaemia Research Institute, Badalona, Spain
Barba P:
Hospital Vall d'Hebron, Barcelona, Spain
Ribera J:
ICO-Hospital Germans Trias i Pujol. Institut de Recerca contra la Leucèmia Josep Carreras, Badalona, Spain
García Cadenas I:
H.Sant Pau, Barcelona
Moreno MJ:
Hospital Universitario Virgen de la Victoria
Martínez-Carballeira D:
Hospital Universitario Central de Asturias, Oviedo, Spain
Torrent A:
Institut Català d'Oncologia-Hospital Germans Trias i Pujol. Josep Carreras Research Institute. Badalona. Universitat Autònoma de Barcelona, Badalona, Spain
Martínez-Sánchez P:
Hospital Doce de Octubre, Madrid, Spain
Monsalvo S:
Hospital Gregorio Marañón, Madrid, Spain
Gil C:
Hospital Alicante, alicante, Spain
Tormo M:
Instituto de Investigación INCLIVA, Spain
Artola MT:
Haematology Services, Hospital Universitario de Donostia, Donostia, South Carolina, Spain
Cervera M:
Haematology Services, Hospital Joan XXIII, Tarragona, Spain
González-Campos J:
Hospital Universitario Virgen del Rocío, Sevilla, Spain
Rodríguez-Medina C:
Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
Bermúdez A:
Haematology Services, Hospital, Santander, Spain
Novo A:
Haematology Services, Hospital Son Espasses, Palma, Spain
Soria B:
Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
Coll R:
Haematological Services, Hospital Josep Trueta, Girona, Spain
Amigo ML:
Hospital Morales Meseguer, Murcia, Spain
:
Hospital Arnau de Villanova, Valencia, Spain
Fernández Martín R:
Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
Serrano J:
University Hospital Reina Sofia, Cordoba, Spain
Mercadal S:
Hospital Duran i Reynals, ICO L´Hospitalet, Barcelona, Spain
Cladera A:
Hospital Son LLàtzer, Palma, Spain
Giménez-Conca AD:
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Peñarrubia MJ:
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Abella E:
Hospital del Mar, Barcelona, Spain
Vall-Llovera F:
Hospital Mútua de Terrassa
Hernández-Rivas JM:
Hospital Universitario, Salamanca, Spain
Garcia A:
Hospital Arnau de Vilanova
Bergua Burgues JM:
Hospital San Pedro de Alcántara. Cáceres, Caceres, Spain
de Rueda B:
Hospital Miguel Servet, Zaragoza, Spain
Sánchez-Sánchez MJ:
Hospital Lucus Augusti, Lugo, Spain
Serrano A:
Hospital HM Sanchinarro, Madrid, Spain
Calbacho M:
Hospital Ramón y Cajal, Madrid, Spain
Alonso Vence N:
HOSPITAL OF SANTIAGO DE COMPOSTELA, santiago de compostela, Spain
Méndez-Sánchez JÁ:
Complejo Hospitalario de Ourense, Ourense, Spain
:
Hospital General Universitario de Castellón, Castellón, Spain
Olivares M:
Hospital de Galdakao, Galdakao, Spain
Barrena S:
Centro de Investigación del Cáncer (IBMCC)
Zamora L:
Hematología. ICO Badalona - HGTiP. Institut d'Investigació contra la Leucèmia Josep Carreras, Badalona, Spain
Granada I:
Institut Català d'Oncologia (ICO)-Hospital Germans Trias i Pujol, Institut de Recerca Contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain., BADALONA, Spain
Lhermitte L:
Université Paris Descartes-Sorbonne Paris Cité, Institut Necker-Enfants-Malades, INSERM UMR1151 APHP, Paris, France
Feliu E:
Institut Català d'Oncologia-Hospital Germans Trias i Pujol. Josep Carreras Research Institute. Badalona. Universitat Autònoma de Barcelona, Badalona, Spain
Orfao A:
University of Salamanca, Salamanca, Spain
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