Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia

Hamilton, Betty K.; Rybicki, Lisa; Abounader, Donna; Adekola, Kehinde; Advani, Anjali S.; Aldoss, Ibrahim; Bachanová, Veronika; Bashey, Asad; Brown, Stacey; Lima, Marcos de; Devine, Steven M.; Flowers, Christopher R.; Ganguly, Siddharth; Jagasia, Madan; Kennedy, Vanessa E.; Kim, Dennis Dong Hwan; McGuirk, Joseph P.; Pullarkat, Vinod; Romee, Rizwan; Sandhu, Karamjeet S.; Smith, Melody; Ueda, Minoru; Viswabandya, Auro; Vu, Khoan; Wall, Sarah; Zeichner, Simon B.; Perales, Miguel Angel; Majhail, Navneet S.

doi:10.1016/j.bbmt.2017.04.003

Cited by 33 publications

(20 citation statements)

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“…Similar data were recently published for adult patients with T-cell ALL. 26 , 27 Based on our present study, we recommend MAC with TBI for fit patients with MPAL as standard regimen. The superiority of MAC over RIC was recently also shown for AML and myelodysplastic syndromes.…”

Section: Discussionmentioning

confidence: 72%

Mixed phenotype acute leukemia: outcomes with allogeneic stem cell transplantation. A retrospective study from the Acute Leukemia Working Party of the EBMT

et al. 2017

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Mixed phenotype acute leukemias are infrequent and considered high risk. The optimal treatment approach and the role of allogeneic hematopoietic stem cell transplantation are not entirely clear. In this study, we investigated 519 patients with mixed phenotype acute leukemia in first complete remission who underwent allogeneic hematopoietic stem cell transplantation between 2000 and 2014, and who were reported to the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Median age was 38.1 years (range 18–75). Cytogenetics classified 49.3% as poor risk. At three years, relapse incidence was 31.4% (26.9–35.9), non-relapse mortality was 22.1% (18.4–26.1), the leukemia-free survival was 46.5% (41.7–51.4), and the overall survival was 56.3% (51.5–61.2). At six months, 32.5% had developed acute graft-versus-host disease, while at three years, 37.5% had developed chronic graft-versus-host disease (32.6–42.3). In a multivariate analysis, age and year of transplant had a strong impact on outcome. Myeloablative conditioning using total body irradiation correlated with a better leukemia-free survival. Our study suggests that mixed phenotype acute leukemia is potentially sensitive to graft-versus-leukemia and thus can benefit from allogeneic hematopoietic stem cell transplantation with a potential for cure.

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Section: Discussionmentioning

confidence: 72%

Mixed phenotype acute leukemia: outcomes with allogeneic stem cell transplantation. A retrospective study from the Acute Leukemia Working Party of the EBMT

et al. 2017

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“…With a median follow-up of 38 months, the 5-year OS reported was 34% for the entire patient population but, in patients with R/R disease, the 5-year OS was only 14%. 21 Nelarabine was granted accelerated approval as an orphan drug by the U. and 5. The CR rate was 31% and the 1-year OS rate was 28%.…”

Section: Discussionmentioning

confidence: 99%

“…One‐quarter of the cases underwent an alternative donor SCT using a mismatched umbilical cord blood or a haploidentical donor. With a median follow‐up of 38 months, the 5‐year OS reported was 34% for the entire patient population but, in patients with R/R disease, the 5‐year OS was only 14% 21 …”

Section: Discussionmentioning

confidence: 99%

“…Stem cell transplant remains the sole potentially curative option for these patients, but there is limited information regarding the feasibility and outcomes of SCT in the adult R/R T-ALL/T-LBL population 20. The most recent and extensive analysis on this population was the multicenter retrospective cohort study performed byHamilton et al (2017), which included 208 adult patients with T-ALL (median age, 37 years) who underwent SCT between 2000 and 2014.…”

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confidence: 99%

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Nelarabine as salvage therapy and bridge to allogeneic stem cell transplant in 118 adult patients with relapsed/refractory T‐cell acute lymphoblastic leukemia/lymphoma. A CAMPUS ALL study

et al. 2020

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The outcome of relapsed or refractory (R/R) T‐cell acute lymphoblastic leukemia/lymphoma (T‐ALL/T‐LBL) in adults is poor, with less than 20% of patients surviving at 5 years. Nelarabine is the only drug specifically approved for R/R T‐ALL/T‐LBL, but the information to support its use is based on limited available data. The aim of this observational phase four study was to provide recent additional data on the efficacy and safety of nelarabine in adults with R/R T‐ALL/T‐LBL and to evaluate the feasibility and outcome of allogeneic hematopoietic stem cell transplant (SCT) after salvage with nelarabine therapy. The primary endpoints were overall response rate (ORR) and overall survival (OS). Additional endpoints were safety, SCT rate and post‐SCT OS. Between May 2007 and November 2018, 118 patients received nelarabine salvage therapy at 27 Italian hematology sites. The median age was 37 years (range 18‐74 years), 73% were male, 77 had a diagnosis of T‐ALL and 41 of T‐LBL, and 65/118 (55%) had received more than two lines of therapy. The median number of nelarabine cycles was two (range 1‐4); 43/118 (36%) patients had complete remission (CR), 16 had partial remission (14%) and 59 (50%) were refractory, with an ORR of 50%. The probability of OS, from the first dose of nelarabine, was 37% at 1 year with a median survival of 8 months. The OS at 1 year was significantly better for the 47 patients (40%) who underwent SCT after nelarabine salvage therapy (58% vs 22%, log‐rank P < .001). The probability of OS at 2 and 5 years from SCT was 46% and 38%, respectively. Seventy‐five patients (64%) experienced one or more drug‐related adverse events (AE). Grade III‐IV neurologic toxicities were observed in 9/118 (8%) of cases and thrombocytopenia or/and neutropenia (grade III‐IV) were reported in 41% and 43% of cases, respectively. In conclusion, this is one of the largest cohorts of adult patients with R/R T‐ALL/T‐LBL treated in real life with nelarabine. Taking into account the poor prognosis of this patient population, nelarabine represents an effective option with an ORR of 50% and a CR rate of 36%. In addition, 40% of cases following nelarabine salvage therapy could undergo SCT with an expected OS at 2 and 5 years of 46% and 38%, respectively. The safety profile of nelarabine was acceptable with only 8% of cases showing grade III‐IV neurological AE.

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“…Conditioning regimens and supportive care practices have been reported previously [2,[29][30][31]. Disease status at transplant was classified by standard criteria [32].…”

Section: Definitionsmentioning

confidence: 99%

Psychosocial Assessment of Candidates for Transplant (PACT) as a tool for psychological and social evaluation of allogeneic hematopoietic cell transplantation recipients

Hong

Rybicki

Corrigan

et al. 2019

Bone Marrow Transplant

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Psychosocial Assessment of Candidates for Transplant (PACT) is a tool originally developed to address psychosocial risks in solid organ transplant recipients and has the potential for application to hematopoietic cell transplantation (HCT) recipients. In a retrospective cohort study, we reviewed 404 adult allogeneic HCT cases from 2003 to 2014 to identify predictors of adverse psychosocial status as determined by PACT. Final PACT rating was poor/borderline (score 0-1) in 5%, acceptable (score 2) in 22%, good (score 3) in 44%, and excellent (score 4) in 29% recipients. In multivariable regression, higher PACT score was associated with White race (odds ratio [OR] 2.95, P < 0.001), having a related donor (OR 1.61, P = 0.015), and a higher quality of life score (OR 1.22/ 10-point increase in FACT-BMT total score, P < 0.001). PACT score correlated with all quality of life subscales. The final PACT score was associated with non-relapse mortality (HR 0.82/ 1-point increase, p = 0.03) in multivariable analysis that considered patient and disease factors, but not in models that also included transplant-related factors and performance status. PACT score was not associated with overall survival. PACT can be considered as part of a comprehensive psychosocial assessment for identifying patients who may require additional resources around allogeneic HCT.

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Allogeneic Hematopoietic Cell Transplantation for Adult T Cell Acute Lymphoblastic Leukemia

Cited by 33 publications

References 10 publications

Mixed phenotype acute leukemia: outcomes with allogeneic stem cell transplantation. A retrospective study from the Acute Leukemia Working Party of the EBMT

Mixed phenotype acute leukemia: outcomes with allogeneic stem cell transplantation. A retrospective study from the Acute Leukemia Working Party of the EBMT

Nelarabine as salvage therapy and bridge to allogeneic stem cell transplant in 118 adult patients with relapsed/refractory T‐cell acute lymphoblastic leukemia/lymphoma. A CAMPUS ALL study

Psychosocial Assessment of Candidates for Transplant (PACT) as a tool for psychological and social evaluation of allogeneic hematopoietic cell transplantation recipients

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