Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes

J. E. Brammer, R. M. Saliba, J. L. Jorgensen, C. Ledesma, S. Gaballa, M. Poon, Richard Maziarz, R. E. Champlin, C. Hosing, P. Kebriaei

Research output: Contribution to journalArticle

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Abstract

This study aims to provide a detailed analysis of allogeneic stem cell transplantation (allo-SCT) outcomes in a large T-cell acute lymphoblastic leukemia (T-ALL) cohort with a specific emphasis on the effects of pre-transplant minimal residual disease (MRD) and disease subtype, including the aggressive early-thymic precursor (ETP) subtype. Data from 102 allo-SCT patients with a diagnosis of T-ALL from three centers were retrospectively analyzed. Patients were grouped into four T-ALL subtypes: ETP, early, cortical and mature. At 3 years, overall survival (OS), PFS, non-relapse mortality and cumulative incidence (CI) progression were 35, 33, 11 and 55%, respectively. Patients transplanted in first complete remission (CR1) had a 3-year OS of 62% versus those transplanted in CR2 or greater (24%) (hazards ratio 1.6, P=0.2). Patients with MRD positivity at the time of transplant had significantly higher rates of progression compared with those with MRD negativity (76 vs 34%, hazards ratio 2.8, P=0.006). There was no difference in OS, PFS or cumulative incidence (CI) progression between disease subtypes, including ETP (n=16). ETP patients transplanted in CR1 (n=10) had OS of 47%, comparable to other disease subtypes, suggesting that allo-SCT can overcome the poor prognosis associated with ETP. MRD status at transplant was highly predictive of disease relapse, suggesting novel therapies are necessary to improve transplant outcomes.Bone Marrow Transplantation advance online publication, 12 September 2016; doi:10.1038/bmt.2016.194.

Original languageEnglish (US)
JournalBone Marrow Transplantation
DOIs
StateAccepted/In press - Sep 12 2016

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Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Residual Neoplasm
Stem Cell Transplantation
Transplants
Survival
Incidence
Bone Marrow Transplantation
Disease Progression
Publications
Recurrence
Mortality

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes. / Brammer, J. E.; Saliba, R. M.; Jorgensen, J. L.; Ledesma, C.; Gaballa, S.; Poon, M.; Maziarz, Richard; Champlin, R. E.; Hosing, C.; Kebriaei, P.

In: Bone Marrow Transplantation, 12.09.2016.

Research output: Contribution to journalArticle

Brammer, J. E. ; Saliba, R. M. ; Jorgensen, J. L. ; Ledesma, C. ; Gaballa, S. ; Poon, M. ; Maziarz, Richard ; Champlin, R. E. ; Hosing, C. ; Kebriaei, P. / Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes. In: Bone Marrow Transplantation. 2016.
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abstract = "This study aims to provide a detailed analysis of allogeneic stem cell transplantation (allo-SCT) outcomes in a large T-cell acute lymphoblastic leukemia (T-ALL) cohort with a specific emphasis on the effects of pre-transplant minimal residual disease (MRD) and disease subtype, including the aggressive early-thymic precursor (ETP) subtype. Data from 102 allo-SCT patients with a diagnosis of T-ALL from three centers were retrospectively analyzed. Patients were grouped into four T-ALL subtypes: ETP, early, cortical and mature. At 3 years, overall survival (OS), PFS, non-relapse mortality and cumulative incidence (CI) progression were 35, 33, 11 and 55{\%}, respectively. Patients transplanted in first complete remission (CR1) had a 3-year OS of 62{\%} versus those transplanted in CR2 or greater (24{\%}) (hazards ratio 1.6, P=0.2). Patients with MRD positivity at the time of transplant had significantly higher rates of progression compared with those with MRD negativity (76 vs 34{\%}, hazards ratio 2.8, P=0.006). There was no difference in OS, PFS or cumulative incidence (CI) progression between disease subtypes, including ETP (n=16). ETP patients transplanted in CR1 (n=10) had OS of 47{\%}, comparable to other disease subtypes, suggesting that allo-SCT can overcome the poor prognosis associated with ETP. MRD status at transplant was highly predictive of disease relapse, suggesting novel therapies are necessary to improve transplant outcomes.Bone Marrow Transplantation advance online publication, 12 September 2016; doi:10.1038/bmt.2016.194.",
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