Trends in the use of hematopoietic stem cell transplantation for adults with acute lymphoblastic leukemia in Europe: a report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

Abstract

Hematopoietic stem cell transplantation (HSCT) is considered an effective way to prevent relapse in adults with acute lymphoblastic leukemia (ALL). This study aimed to assess general trends in the use of various types of HSCTs performed between 2001 and 2015 in Europe, based on data reported to the European Society for Blood and Marrow Transplantation registry. We also evaluated HSCT rates with respect to ALL incidence in selected countries. Altogether, 15,346 first allogeneic (n = 13,460) or autologous (n = 1886) HSCTs were performed in the study period. Comparing 2013–2015 and 2001–2003, the number of allogeneic HSCTs performed in first complete remission increased by 136%, most prominently for transplantations from unrelated (272%) and mismatched related donors (339%). The number of HSCTs from matched sibling donors increased by 42%, while the total number of autologous HSCTs decreased by 70%. Increased use of allogeneic HSCT was stronger for Philadelphia chromosome (Ph)-positive (166%) than for Ph-negative ALL (38%) and for patients aged > 55 years (599%) than for younger adults (59%). The proportion of allogeneic HSCT with reduced-intensity conditioning (RIC) increased from 6 to 27%. The age-standardized rates of allogeneic HSCT per ALL incidence varied strongly among countries. Our analysis showed a continued trend toward increased allogeneic HSCT use for adults with ALL, which may be attributed to increasing availability of unrelated donors, wider use of RIC regimens, and improving efficacy of pretransplant therapy, including tyrosine kinase inhibitors for Ph-positive ALL. Allogeneic HSCT remains a major tool in the fight against ALL in adults.

Hematopoietic stem cell transplantation for adults with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission: a position statement of the European Working Group for Adult Acute Lymphoblastic Leukemia (EWALL) and the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT)

“…Initially MSDs predominated, but with increasing number of unrelated volunteers, URD-HSCT became the most popular option. According to a recent EBMT report focused on adults with ALL, between years 2010 and 2012, transplantations from unrelated donors accounted for 52% of all procedures, followed by MSD-HSCT (37%), MMRD-HSCT (5%) and autoHSCT (6%) [31].…”

Anti‐thymocyte globulin improves survival free from relapse and graft‐versus‐host disease after allogeneic peripheral blood stem cell transplantation in patients with Philadelphia‐negative acute lymphoblastic leukemia: An analysis by the Acute Leukemia Working Party of theEBMT

“…19 We have chosen only PBSCs as a source of grafts because of their predominant use and association with an increased risk of cGVHD, which provides a strong rationale for the administration of ATG. 5,6,8 In this homogeneous population of patients with Ph-neg ALL, we were able to demonstrate the beneficial role of ATG in terms of reducing the risk of aGVHD and cGVHD and increasing the probability of GRFS. Importantly, the effect on cGVHD could be demonstrated, regardless of the donor type.…”

“…Furthermore, we have restricted the analysis to Ph‐neg ALL because modern treatment protocols for patients with the presence of the Philadelphia chromosome differ considerably . We have chosen only PBSCs as a source of grafts because of their predominant use and association with an increased risk of cGVHD, which provides a strong rationale for the administration of ATG . In this homogeneous population of patients with Ph‐neg ALL, we were able to demonstrate the beneficial role of ATG in terms of reducing the risk of aGVHD and cGVHD and increasing the probability of GRFS.…”

“…Furthermore, cGVHD affects up to 80% of long‐term transplant survivors and results in an increased risk of infections, multiorgan dysfunction, prolonged administration of immunosuppressive drugs, and impaired quality of life . During the last decade, mobilized peripheral blood stem cells (PBSCs) have become the predominant source of grafts for allo‐SCT in adults . In comparison with bone marrow transplantation, PBSC transplantation allows significantly faster neutrophil and platelet engraftment, but it is associated with an increased risk of overall and extensive cGVHD .…”

“…6,7 During the last decade, mobilized peripheral blood stem cells (PBSCs) have become the predominant source of grafts for allo-SCT in adults. 5,8 In comparison with bone marrow transplantation, PBSC transplantation allows significantly faster neutrophil and platelet engraftment, but it is associated with an increased risk of overall and extensive cGVHD. 6 It results most likely from the higher content of donor T cells in PBSC grafts, which play a pivotal role in the pathogenesis of graft-versus-host reactions.…”