Improvements in allogeneic hematopoietic cell transplantation outcomes for adults with ALL over the past 3 decades

Author:

Nishiwaki Satoshi1ORCID,Akahoshi Yu23ORCID,Morita-Fujita Mari4,Shimizu Hiroaki5ORCID,Uchida Naoyuki6,Ozawa Yukiyasu7,Fukuda Takahiro8,Tanaka Masatsugu9,Ikegame Kazuhiro10,Ota Shuichi11ORCID,Katayama Yuta12ORCID,Takahashi Satoshi13,Kawakita Toshiro14,Ara Takahide15ORCID,Onizuka Makoto16,Kimura Takafumi17,Tanaka Junji18,Atsuta Yoshiko1920,Arai Yasuyuki4ORCID

Affiliation:

1. 1Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan;

2. 2Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan;

3. 3Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY;

4. 4Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;

5. 5Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan;

6. 6Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan;

7. 7Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan;

8. 8Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan;

9. 9Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan;

10. 10Department of Hematology, Hyogo College of Medicine Hospital, Nishinomiya, Japan;

11. 11Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan;

12. 12Department of Hematology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan;

13. 13Division of Clinical Precision Research Platform, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan;

14. 14Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan;

15. 15Department of Hematology, Hokkaido University Hospital, Sapporo, Japan;

16. 16Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan;

17. 17Preparation Department, Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan;

18. 18Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan;

19. 19Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; and

20. 20Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

Abstract

Abstract Allogeneic hematopoietic cell transplantation (allo-HCT) is a promising treatment for adult acute lymphoblastic leukemia (ALL), an intractable hematological malignancy. The trends in allo-HCT outcomes over the past 30 years were examined to verify the efficacy of evolving treatment methods and to identify further challenges. We analyzed data from a registry database that included 8467 adult ALL patients who underwent their first allo-HCT between 1990 and 2019. The period was divided into three 10-year intervals for analysis. Five-year overall survival improved from 48.2% to 70.2% in the first complete remission (CR1), from 25.6% to 44.1% in subsequent CR, and from 10.0% to 22.7% in non-CR. Nonrelapse mortality improved over the 3 decades in each disease stage. However, the relapse rate only improved in CR1 every decade (26.3% to 15.9% in CR1, 33.4% to 32.8% in subsequent CR, and 53.6% to 54.8% in non-CR). Although there were continual improvements in adjusted survival for Philadelphia chromosome (Ph)-positive patients, the improvement was inadequate for Ph− patients with t(4;11), t(8;14), t(14;18), or hypodiploidy. Allo-HCT outcomes for adults with ALL have improved over the past 30 years. Improved outcomes in the future will require more effective prevention of relapse in patients with ALL not in CR1 and in those with high-risk chromosomal abnormalities.

Publisher

American Society of Hematology

Subject

Hematology

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