Outcomes and prognostic factors of adults with refractory or relapsed T-cell acute lymphoblastic leukemia included in measurable residual disease-oriented trials
Por:
Ribera, J, Morgades, M, Genesca, E, Chapchap, E, Montesinos, P, Acuna-Cruz, E, Gil, C, Garcia-Cadenas, I, Barba, P, Gonzalez-Campos, J, de Llano, M, Torrent, A, Ribera, J, Granada, I, Bernal, T, Diaz-Beya, M, Amigo, M, Coll, R, Tormo, M, Vall-llovera, F, Gomez-Centurion, I, Sanchez-Sanchez, M, Soria, B, Cladera, A, Artola, M, Garcia-Guinon, A, Gimenez-Conca, A, Amador, M, Martinez-Sanchez, P, Algarra, J, Vidal, M, Alonso, N, Maluquer, C, Llorente, L, Garcia-Boyero, R, Ciudad, J, Feliu, E, Orfao, A and PETHEMA Grp
Publicada:
1 oct 2021
Ahead of Print:
1 ago 2021
Resumen:
Despite high complete remission (CR) rates with frontline therapy, relapses are frequent in adults with T-cell acute lymphoblastic leukemia (T-ALL) with limited salvage options. We analyzed the outcomes and prognostic factors for CR to salvage therapy and overall survival (OS) of patients with R/R T-ALL included in two prospective measurable residual disease-oriented trials. Seventy-five patients (70 relapsed, 5 refractory) were identified. Relapses occurred in bone marrow, isolated or combined in 50 patients, and in the central nervous system (CNS; isolated or combined) in 20. Second CR was attained in 30/75 patients (40%). Treatment with FLAG-Ida and isolated CNS relapse were independently associated with a higher CR rate after first salvage therapy. The median OS was 6.2 (95% confidence interval [CI], 3.9-8.6) months, with a 4-year OS probability of 18% (95% CI, 9%-27%). No differences in survival were observed according to the treatment with hematopoietic stem cell transplantation in patients in CR after first salvage therapy. Multivariable analysis showed a >= 12-month interval between first CR and relapse, CR after first salvage therapy and isolated CNS relapse as favorable prognostic factors for OS with hazard ratios (HR) (95% CI) of 1.931 (1.109-3.362), 2.958 (1.640-5.334), and 2.976 (1.157-7.655), respectively. This study confirms the poor outcomes of adults with R/R T-ALL among whom FLAG-Ida was the best of the rescue therapies evaluated. Late relapse, CR after first rescue therapy and isolated CNS relapse showed prognostic impact on survival. More effective rescue therapies are needed in adults with R/R T-ALL.
Filiaciones:
Ribera, J:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Morgades, M:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Genesca, E:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Chapchap, E:
Hosp Israelita Albert Einstein, Hematol Dept, Sao Paulo, Brazil
Montesinos, P:
Hosp Univ & Politen La Fe, Hematol Dept, Valencia, Spain
Acuna-Cruz, E:
Hosp Univ & Politen La Fe, Hematol Dept, Valencia, Spain
:
Hosp Gen Alicante, Hematol Dept, Alicante, Spain
Garcia-Cadenas, I:
Hosp Santa Creu & Sant Pau, Hematol Dept, Barcelona, Spain
Barba, P:
Hosp Univ Vall dHebron, Hematol Dept, Barcelona, Spain
Gonzalez-Campos, J:
Hosp Univ Virgen Rocio, Hematol Dept, Seville, Spain
de Llano, M:
Hosp Univ Virgen Victoria, Hematol Dept, Malaga, Spain
Torrent, A:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Ribera, J:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Granada, I:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Bernal, T:
IUOPA, ISPA, Hosp Cent Asturias, Hematol Dept, Oviedo, Spain
Diaz-Beya, M:
Hosp Clin Barcelona, Hematol Dept, Barcelona, Spain
Amigo, M:
Hosp Morales Meseguer, Hematol Dept, Murcia, Spain
Coll, R:
Hosp Josep Trueta, Inst Catala Oncol, Hematol Dept, Girona, Spain
Tormo, M:
Hosp Clin Univ, Inst Invest INCLIVA, Hematol & Oncol Dept, Valencia, Spain
Vall-llovera, F:
Hosp Univ Mutua Terrasa, Hematol Dept, Terrassa, Spain
Gomez-Centurion, I:
Hosp Gen Univ Gregorio Maranon, Hematol Dept, Madrid, Spain
Sanchez-Sanchez, M:
Hosp Univ Lucus Augusti, Hematol Dept, Lugo, Spain
:
Hosp Univ Canarias, Hematol Dept, Santa Cruz De Tenerife, Spain
Cladera, A:
Hosp Son Llatzer, Hematol Dept, Palma De Mallorca, Spain
Artola, M:
Hosp Univ Donostia, Hematol Dept, Donostia San Sebastian, Spain
Garcia-Guinon, A:
Hosp Arnau Vilanova, Hematol Dept, Lleida, Spain
Gimenez-Conca, A:
Hosp Italiano Buenos Aires, Hematol Dept, Buenos Aires, DF, Argentina
Amador, M:
Complejo Hosp Pontevedra, Hematol Dept, Pontevedra, Spain
Martinez-Sanchez, P:
Hosp 12 Octubre, Hematol Dept, Madrid, Spain
Algarra, J:
Hosp Gen Univ Albacete, Hematol Dept, Albacete, Spain
Vidal, M:
Hosp Univ Leon, Hematol Dept, Leon, Spain
Alonso, N:
Hosp Univ Santiago Compostela, Hematol Dept, Santiago, Spain
Maluquer, C:
Hosp Duran & Reynals, Inst Catala Oncol, Hematol Dept, Barcelona, Spain
Llorente, L:
Hosp HM Sanchinarro, Hematol Dept, Madrid, Spain
Garcia-Boyero, R:
Hosp Gen Univ Castellon, Hematol Dept, Castellon de La Plana, Spain
Ciudad, J:
Univ Salamanca, CSIC, Hosp Univ, Hematol Dept,Ctr Invest Canc,IBSAL,IBMCC,CIBERONC, Salamanca, Spain
:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Hematol Dept,Inst Catala Oncol, Barcelona, Spain
Orfao, A:
Univ Salamanca, CSIC, Hosp Univ, Hematol Dept,Ctr Invest Canc,IBSAL,IBMCC,CIBERONC, Salamanca, Spain
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