Pediatric chemotherapy versus allo-HSCT for adolescent and adult Philadelphia chromosome-negative ALL in first complete remission: a meta-analysis

Pan, Zengkai; Wang, Luxiang; Fu, Weijia; Jiang, Chun‐Lei; Chen, Qi; Wang, Libing; Hu, Xiaoxia

doi:10.1007/s00277-023-05160-2

Cited by 2 publications

(3 citation statements)

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“…Our recent systematic review also did not observe the benefit of allo‐HSCT in HR patients. Neither did the subgroup analysis based on risk categories reveal significant differences in OS or DFS between the allo‐HSCT and chemotherapy arms for both the HR and SR groups 32 . Nowadays, in the era of immunotherapy, several groups recently reported good outcomes in adult ALL patients treated with novel therapies such as monoclonal antibodies and CAR‐T cells 33,34 .…”

Section: Discussionmentioning

confidence: 99%

“…Neither did the subgroup analysis based on risk categories reveal significant differences in OS or DFS between the allo-HSCT and chemotherapy arms for both the HR and SR groups. 32 Nowadays, in the era of immunotherapy, several groups recently reported good outcomes in adult ALL patients treated with novel therapies such as monoclonal antibodies and CAR-T cells. 33,34 Therefore, the optimal treatment of adult patients with B-ALL in CR1 still remains to be established because the risk/benefit ratio associated with allo-HSCT.…”

Section: Discussionmentioning

confidence: 99%

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Effect of sustained measurable residue disease negativity and post‐remission treatment selection on the prognosis of acute lymphoblastic leukemia in adults

Yu,

Luo,

Wang

et al. 2024

Cancer Medicine

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BackgroundTo explore the effects of monitoring measurable residual disease and post‐remission treatment selection on the clinical outcomes of B‐cell acute lymphoblastic leukemia (B‐ALL) in adults.MethodsBetween September 2010 and January 2022, adult patients with B‐ALL who received combination chemotherapy, with or without allogeneic hematopoietic stem cell transplantation (allo‐HSCT), were included in the retrospective study, which was approved by the Ethics Committee and the observation of Declaration of Helsinki conditions.ResultsOne hundred and forty‐three B‐ALL patients achieved complete remission (CR) were included in the study, of whom 94 patients (65.7%) received allo‐HSCT in first complete remission (CR1).Multivariate analysis showed that the most powerful factors affecting OS were transplantation (hazard ratio [HR] = 0.540, p = 0.037) and sustained measurable residue disease (MRD) negativity (HR = 0.508, p = 0.037). The subgroup analysis showed that the prognosis of the allo‐HSCT group was better than that of the chemotherapy group, regardless of whether MRD was negative or positive after two courses of consolidation therapy. After consolidation therapy, the prognosis of patients with positive MRD remained significantly better in the allo‐HSCT group than in the chemotherapy group. However, no significant difference was observed in the prognosis between the allo‐HSCT and chemotherapy groups with negative MRD after consolidation therapy.ConclusionsB‐ALL patients who achieve sustained MRD negativity during consolidation therapy have excellent long‐term outcomes even without allo‐HSCT. Allo‐HSCT is associated with a significant benefit in terms of OS and DFS for patients who were with positive MRD during consolidation therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of sustained measurable residue disease negativity and post‐remission treatment selection on the prognosis of acute lymphoblastic leukemia in adults

Yu,

Luo,

Wang

et al. 2024

Cancer Medicine

Self Cite

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“…Several studies compared outcomes between pediatric-like regimen and allo-HSCT in adult ALL, revealing that allo-HSCT does not exhibit superiority over pediatric-inspired regimen [8,9] . Recently, a meta-analysis including 13 trials and 3161 patients demonstrated the superiority of pediatric-inspired chemotherapy over allo-HSCT for adult ALL in CR1 [10] . However, these studies did not provide a clear conclusion regarding the bene t of allo-HSCT in HR-ALL.…”

Section: Introductionmentioning

confidence: 99%

Superior Survival with Allogeneic Hematopoietic Stem Cell Transplantation versus Chemotherapy for High-Risk Adult Acute Lymphoblastic Leukemia in PDT-ALL-2016 Pediatric-Inspired Cohort

Zhou,

Chen,

Cai

et al. 2024

Preprint

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The role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for adult high-risk acute lymphoblastic leukemia (HR-ALL) remained elusive in the pediatric-inspired regimen era. We conducted a cohort study on the outcome of allo-HSCT post-consolidation versus chemotherapy for HR-ALL in the first complete remission in PDT-ALL-2016 pediatric-inspired cohort. A total of 245 patients with HR-ALL were enrolled, according to donor availability and patients’ preferences, among which 159 received allo-HSCT after consolidation therapy, and 86 received post-remission chemotherapy. With a median follow-up of 43.6 months, the 3-year overall survival (OS) in allo-HSCT cohort was 77.1% (70.6–84.2%), and 51.7% (41.7–64.1%) in chemotherapy cohort, respectively (p < .001). In multivariate analysis, allo-HSCT cohort showed superior OS (HR = 0.33, 0.21–0.54, p < .001), event-free-survival (EFS, HR = 0.36, 0.23–0.56, p < .001), cumulative incidence of relapse (CIR, HR = 0.13, 0.07–0.22, p < .001), and increased non-relapse mortality (NRM, HR = 4.06, 1.23–13.4, p = .021), compared to chemotherapy cohort. Notably, allo-HSCT improved the outcome of minimal residue disease (MRD)-positive subset (OS, HR = 0.42,0.20–0.90, p = .025), as well as MRD-negative subset (OS, HR = 0.21, 0.10–0.43, p < .001). Our study demonstrates that allo-HSCT post-consolidation, compared to chemotherapy, could further improve survival of HR-ALL in pediatric-inspired cohort, regardless of MRD status.

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Pediatric chemotherapy versus allo-HSCT for adolescent and adult Philadelphia chromosome-negative ALL in first complete remission: a meta-analysis

Cited by 2 publications

References 50 publications

Effect of sustained measurable residue disease negativity and post‐remission treatment selection on the prognosis of acute lymphoblastic leukemia in adults

Effect of sustained measurable residue disease negativity and post‐remission treatment selection on the prognosis of acute lymphoblastic leukemia in adults

Superior Survival with Allogeneic Hematopoietic Stem Cell Transplantation versus Chemotherapy for High-Risk Adult Acute Lymphoblastic Leukemia in PDT-ALL-2016 Pediatric-Inspired Cohort

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