Open AccessAcute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study
Author(s) -
Alexandre Desjonqueres,
Patrice Chevallier,
Xavier Thomas,
Françoise Huguet,
Thibaud Leguay,
Maryse Bernard,
J.-O. Bay,
Emmanuelle Tavernier,
A Charbonnier,
F Isnard,
Mathilde Hunault,
Pascal Turlure,
Marc Renaud,
J-N Bastié,
Chantal Himberlin,
Stéphane Leprêtre,
Bruno Lioure,
Véronique Lheritier,
Vahid Asnafi,
Kheïra Beldjord,
Marina LafagePochitaloff,
Marie C. Béné,
Norbert Ifrah,
Hervé Dombret
Publication year - 2016
Publication title -
blood cancer journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.607
H-Index - 51
ISSN - 2044-5385
DOI - 10.1038/bcj.2016.111
Subject(s) - medicine , multivariate analysis , lymphoblastic leukemia , leukemia , salvage therapy , young adult , pediatrics , chemotherapy
The outcome of adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph− ALL) relapsing after pediatric-inspired front-line therapy is ill known. Here 229 relapsing Ph− ALL younger adults (18–63 years) treated within the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-2003/-2005 trials were considered. Salvage regimens consisted of potentially curative therapies in 194 cases, low-intensity therapies in 21, allogeneic stem cell transplant (allo-SCT) in 6 and best supportive care in 8. Overall, 77 patients received allo-SCT after relapse. The median follow-up was 3.1 years. A second complete remission (CR2) was achieved in 121 patients (53%). In multivariate analysis, only younger age <45 years ( P =0.008) and CR1 duration ⩾18 months ( P =0.009) predicted CR2. Overall survival (OS) at 2 and 5 years was 19.3% (14–24%) and 13.3% (8–18%), respectively. In CR2 patients, disease-free survival (DFS) at 2 and 5 years was 29.0% (21–38%) and 25% (17–33%). In multivariate analysis, CR1 duration ⩾18 months and allo-SCT after relapse were associated with longer DFS ( P <0.009 and P =0.004, respectively) and longer OS ( P =0.004 and P <0.0001, respectively). In conclusion, although younger adults relapsing after pediatric-inspired ALL therapies retain a poor outcome, some of them may be cured if CR1 duration ⩾18 months and if allo-SCT can be performed in CR2. New therapies are definitely needed for these patients.