The role of maintenance chemotherapy after autotransplantation for acute lymphoblastic leukemia in first remission: single-center experience of 100 patients

Abstract

A total of 100 adults with ALL in first CR received melphalan (110 mg/m 2 ) with TBI followed by autologous marrow (n ¼ 35) or single-agent melphalan (200 mg/m 2 ) followed by autologous blood stem cells (n ¼ 65). After adequate hematologic recovery, maintenance chemotherapy with 6-mercaptopurine, methotrexate and vincristine-prednisone was administered for 2 years. Six patients, all TBI recipients (P ¼ 0.001), died of toxicity. In total 70 patients received 6-mercaptopurine, 53 received methotrexate and 40 received vincristine-prednisone. The cumulative incidence of relapse at 7 years was 45%. The 7-year probabilities of disease-free survival (DFS) and overall survival were 45 and 48%. Age 30 years, 44 weeks to attain remission, and karyotypes t(4;11) and t(9;22) were associated with adverse outcome. Patients with 0 (standard risk), 1 (intermediate risk), and 2-3 (high risk) adverse features had 7-year cumulative incidences of relapse of 19, 53 and 82% (Po0.0001), and 7-year DFS probabilities of 73, 36 and 7% (Po0.0001). The 7-year probabilities of DFS for patients receiving 0, 1, 2 and 3 maintenance chemotherapy agents were 15, 29, 58 and 61% (Po0.0001). Maintenance chemotherapy intensity was an independent determinant of outcome in Cox analysis. Maintenance chemotherapy after autotransplantation reduces relapse and improves outcome in adult patients with ALL.

Outcomes of Adults with Acute Lymphoblastic Leukemia After Autologous Hematopoietic Stem Cell Transplantation and the Significance of Pretransplantation Minimal Residual Disease

“…[ 12 ] Similarly, Sirohi et al . [ 13 ] and Mehta et al . [ 14 ] also found that maintenance chemotherapy after auto-HSCT could diminish the relapse rate as well as improve the prognosis.…”

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

“…The 7-year probabilities of DFS for patients receiving zero, one, two and three maintenance chemotherapy agents were 15%, 29%, 58% and 61%, respectively (P ¼ 0.0001). 34 Only four prospective studies designed patients to receive maintenance therapy after auto-SCT, 4,6,7,10 and only 12 --52% patients actually took maintenance therapy. This may lead to an underestimation of the real potency of auto-SCT.…”

Role of allogeneic hematopoietic cell transplantation in adults with acute lymphoblastic leukemia

“…The preponderance of evidence shows that there were no differences in outcomes between these groups. Other studies [27,28] have demonstrated that long-term maintenance chemotherapy remains a critical component to achieve the best possible outcome even for patients undergoing high-dose therapy followed by auto-HCT.…”