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Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR.

Publication ,  Journal Article
Wieduwilt, MJ; Stock, W; Advani, A; Luger, S; Larson, RA; Tallman, M; Appelbaum, F; Zhang, M-J; Bo-Subait, K; Wang, H-L; Bhatt, VR; Eapen, M ...
Published in: Leukemia
July 2021

Optimal post-remission therapy for adolescents and young adults (AYAs) with Ph-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1) is not established. We compared overall survival (OS), disease-free survival (DFS), relapse, and non-relapse mortality (NRM) for patients receiving post-remission therapy on CALGB 10403 to a cohort undergoing myeloablative (MA) allogeneic hematopoietic cell transplantation (HCT) in CR1. In univariate analysis, OS was superior with chemotherapy compared to MA allogeneic HCT (3-year OS 77% vs. 53%, P < 0.001). In multivariate analysis, allogeneic HCT showed inferior OS (HR 2.00, 95% CI 1.5-2.66, P < 0.001), inferior DFS (HR 1.62, 95% CI 1.25-2.12, P < 0.001), and increased NRM (HR 5.41, 95% CI 3.23-9.06, P < 0.001) compared to chemotherapy. A higher 5-year relapse incidence was seen with chemotherapy compared to allogeneic HCT (34% vs. 23%, P = 0.011). Obesity was independently associated with inferior OS (HR 2.17, 95% CI 1.63-2.89, P < 0.001), inferior DFS (HR 1.97, 95% CI 1.51-2.57, P < 0.001), increased relapse (1.84, 95% CI 1.31-2.59, P < 0.001), and increased NRM (HR 2.10, 95% CI 1.37-3.23, P < 0.001). For AYA ALL patients in CR1, post-remission therapy with pediatric-style chemotherapy is superior to MA allogeneic HCT for OS, DFS, and NRM.

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Published In

Leukemia

DOI

EISSN

1476-5551

ISSN

0887-6924

Publication Date

July 2021

Volume

35

Issue

7

Start / End Page

2076 / 2085

Related Subject Headings

  • Young Adult
  • Transplantation, Homologous
  • Transplantation Conditioning
  • Remission Induction
  • Recurrence
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Male
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wieduwilt, Matthew J., Wendy Stock, Anjali Advani, Selina Luger, Richard A. Larson, Martin Tallman, Frederick Appelbaum, et al. “Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR.Leukemia 35, no. 7 (July 2021): 2076–85. https://doi.org/10.1038/s41375-021-01213-5.
Wieduwilt MJ, Stock W, Advani A, Luger S, Larson RA, Tallman M, Appelbaum F, Zhang M-J, Bo-Subait K, Wang H-L, Bhatt VR, Dholaria B, Eapen M, Hamadani M, Jamy O, Prestidge T, Pulsipher M, Ritchie D, Rizzieri D, Sharma A, Barba P, Sandmaier BM, de Lima M, Kebriaei P, Litzow M, Saber W, Weisdorf D. Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: analysis from CALGB 10403 and the CIBMTR. Leukemia. 2021 Jul;35(7):2076–2085.

Published In

Leukemia

DOI

EISSN

1476-5551

ISSN

0887-6924

Publication Date

July 2021

Volume

35

Issue

7

Start / End Page

2076 / 2085

Related Subject Headings

  • Young Adult
  • Transplantation, Homologous
  • Transplantation Conditioning
  • Remission Induction
  • Recurrence
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Male
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation