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Incidence, treatment and outcome of central nervous system relapse in adult acute lymphoblastic leukaemia patients treated front‐line with paediatric‐inspired regimens: A retrospective multicentre Campus ALL study
Author(s) -
Dargenio Michelina,
Bonifacio Massimiliano,
Chiaretti Sabina,
Vitale Antonella,
Fracchiolla Nicola Stefano,
Papayannidis Cristina,
Giglio Fabio,
Salutari Prassede,
Audisio Ernesta,
Scappini Barbara,
Zappasodi Patrizia,
Defina Marzia,
Forghieri Fabio,
Scattolin Anna Maria,
Todisco Elisabetta,
Lunghi Monia,
Guolo Fabio,
Del Principe Maria Ilaria,
Annunziata Mario,
Lazzarotto Davide,
Cedrone Michele,
Pasciolla Crescenza,
Imovilli Annalisa,
Tanasi Ilaria,
Trappolini Silvia,
Cerrano Marco,
La Starza Roberta,
Krampera Mauro,
Di Renzo Nicola,
Candoni Anna,
Pizzolo Giovanni,
Ferrara Felicetto,
Foà Robin
Publication year - 2023
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.18537
Subject(s) - medicine , incidence (geometry) , multivariate analysis , chemotherapy , radiation therapy , central nervous system , acute lymphocytic leukemia , oncology , lymphoblastic leukemia , pediatrics , leukemia , physics , optics
Summary Within the Campus ALL network we analyzed the incidence, characteristics, treatment and outcome of a central nervous system (CNS) relapse in 1035 consecutive adult acute lymphoblastic leukemia (ALL) patients treated frontline with pediatric‐inspired protocols between 2009 and 2020. Seventy‐one patients (6.8%) experienced a CNS recurrence, more frequently in T‐ (28/278; 10%) than in B‐ALL (43/757; 5.7%) ( p = 0.017). An early CNS relapse—< 12 months from diagnosis—was observed in 41 patients. In multivariate analysis, risk factors for early CNS relapse included T‐cell phenotype ( p = <0.001), hyperleucocytosis >100 × 10 9 /L ( p <0.001) and male gender ( p = 0.015). Treatment was heterogeneous, including chemotherapy, radiotherapy, intrathecal therapy and novel agents. A complete remission (CR) was obtained in 39 patients (55%) with no differences among strategies. After CR, 26 patients underwent an allogenic transplant, with a significant overall survival benefit compared to non‐transplanted patients ( p = 0.012). After a median observation of 8 months from CNS relapse, 23 patients (32%) were alive. In multivariate analysis, the time to CNS relapse was the strongest predictor of a lower 2‐year post‐relapse survival ( p <0.001). In conclusion, in adult ALL the outcome after a CNS relapse remains very poor. Effective CNS prophylaxis remains the best approach and allogenic transplant should be pursued when possible.