An auto-SCT-based total therapy resulted in encouraging outcomes in adolescents and young adults with acute lymphoblastic leukemia: report from a single center of China

Abstract

Application of auto-SCT in the post-remission therapy for adolescents and young adults (AYAs) with ALL is controversial. We analyzed the outcomes of 79 AYAs (15 --24 years) with ALL who received our designed total therapy protocol with auto-SCT in first CR from 1990 to 2009. The estimated OS and EFS at 5 years for the cohort were 62.8±5.9 and 61.5±5.7%. The cumulative non-relapse mortality and relapse rate at 5 years for the cohort were 7.2 ± 3.1 and 33.6 ± 5.8%. Time to CR 44 weeks was the only independent unfavorable factor associated with OS, EFS and relapse in multivariate analysis. Patients in standard risk (SR) group and high risk (HR) group had better OS (78.3±7.4, 63.8±10.2 vs 38.1±11.6%) and EFS (78.0±7.4, 63.4±9.4 vs 32.4±11.3%), and lower relapse rate (15.9±6.5, 31.5±9.5 vs 65.7±11.8%) compared with patients in very high risk (VHR) group. Our data confirmed that auto-SCT-based total therapy might be an optional treatment strategy for AYAs with ALL in SR. Patients in HR also could get benefit from such schedule. But for those in VHR, allogenetic SCT is still the prior recommendation for the frequent recurrence after auto-SCT.

In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

“…[27][28][29][30][31][32] Unfortunately, despite analysing 128 autologous transplants, we were unable to identify any risk factors that impacted on OS and relapse. Unlike diverse TBI schedules that were used in conditioning to autologous transplantation, [27][28][29]31 ours were strongly skewed in favor of hyperfractionated schemes. For this reason, it was hardly surprising that neither total nor lung dose emerged as significant risk factors.…”

“…Age was the only factor that tended towards significance for OS in univariate analysis Impact of TBI on transplantation outcomes C Aristei et al (67%p18 years vs 50% for age418 years, P ¼ 0.061). Although the cutoff was usually higher in other series than in ours, 27,28,31,32 we chose 18 years so as to analyse adults and children separately and because 12 years was the median age in the entire cohort of autologous transplants. Despite this cutoff, the age distribution was still imbalanced as 2/3 of patients were 18 years old or younger.…”

Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects

“…Some recent studies, however, remain in favor of ASCT; in a limited unicentric series 28 of 79 adolescents with ALL who received a 'total therapy protocol' based on ASCT in CR1 from 1990 to 2009, OS and LFS at 5 years were 63 and 62%. Time to CR44 weeks was the only unfavorable prognostic factor by multivariate analysis.…”