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Allogeneic HSCT improved outcomes for children with relapsed ALL
Allogeneic hematopoietic stem cell transplantation considerably improved the prognosis of patients with acute lymphoblastic leukemia who demonstrated unsatisfactory reduction of minimal residual disease after induction therapy and were at intermediate risk for relapse, according to study results.
The analysis included 208 patients.
Ninety-nine patients with minimal residual disease (MRD) levels ≥10-3 after induction therapy were eligible for hematopoietic stem cell transplantation (HSCT). Of them, 88 underwent transplantation.
The 109 patients with MRD <10-3 continued to undergo chemotherapy.
Cornelia Eckert, PhD, of Charite Universitatsmedizin Berlin in Germany, and colleagues determined the probability of EFS among the patients who underwent HSCT was 64% ± 5%. That was more than three times higher than the 18% ± 7% probability of EFS rate reported in a preceding study in which patients with unsatisfactory reduction of MRD did not undergo HSCT (P<.001).
The cumulative incidence of subsequent relapse at 8 years also declined, from 59% in the preceding trial to 27% in the current study (P<.001), researchers wrote.
Among the subset of patients with good molecular response, those with an early combined bone marrow relapse had a significantly lower probability of EFS compared with those who experienced a late combined or isolated bone marrow relapse (37% ± 13% vs. 76% ± 5%; P=.026), the researchers wrote. Researchers noted that difference can be attributed primarily to a higher rate of subsequent relapse (20% ± 5% vs. 63% ± 13%; P<.001).
"Allogeneic HSCT markedly improved the prognosis of patients with intermediate risk of relapse of ALL and unsatisfactory MRD response," Eckert and colleagues concluded. "As a result, outcomes in this group approximated those of patients with favorable MRD response. Patients with early combined relapse require treatment intensification even in case of favorable MRD response, demonstrating the prognostic impact of time to relapse."