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Increased survival due to lower toxicity for high‐risk T‐cell acute lymphoblastic leukemia patients in two consecutive pediatric‐inspired PETHEMA trials
Author(s) -
Barba Pere,
Morgades Mireia,
Montesinos Pau,
Gil Cristina,
Fox MaríaLaura,
Ciudad Juana,
Moreno MaríaJosé,
GonzálezCampos José,
Genescà Eulàlia,
MartínezCarballeira Daniel,
Martino Rodrigo,
Vives Susana,
Guardia Ramon,
Mercadal Santiago,
Artola MaríaTeresa,
Cladera Antonia,
Tormo Mar,
Esteve Jordi,
Bergua Juan,
VallLlovera Ferran,
Ribera Jordi,
MartínezSanchez Pilar,
Amigo MaríaLuz,
Bermúdez Arantxa,
Calbacho María,
HernándezRivas JesúsMaria,
Feliu Evaristo,
Orfao Alberto,
Ribera JosepMaría
Publication year - 2019
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13178
Subject(s) - medicine , hematopoietic stem cell transplantation , minimal residual disease , toxicity , transplantation , disease , clinical trial , oncology , lymphoblastic leukemia , leukemia
Objective and methods Pediatric‐inspired regimens have been adopted by several groups as the treatment strategy for adult patients with acute lymphoblastic leukemia (ALL). Whether subsequent modifications of these protocols have led to an improvement in the outcome of patients is uncertain, especially in T‐cell ALL. We analyzed 169 patients with high‐risk T‐cell ALL included in two consecutive trials of the PETHEMA Group (HR‐ALL03 [n = 104] and the more contemporary HR‐ALL11 [n = 65]). Results Patients and disease characteristics were balanced between both groups. Regarding efficacy, we observed a similar complete remission (CR) rate, relapse and disease‐free survival (DFS) between both protocols. Patients included in the HR‐ALL11 trial had better 2‐year overall survival (OS) compared with the HR‐ALL03 (65% [95% CI 51%‐79%] vs 44% [95% CI 34%‐54%], P = 0.026). Regarding toxicity, we observed a better safety profile in the HR‐11 protocol. Irrespective of the protocol, patients with good measurable residual disease (MRD) clearance had a promising outcome without allogeneic hematopoietic stem cell transplantation (allo‐HSCT) in CR1, with 2‐year OS of 67%. Conclusion Patients with T‐cell ALL included in the HR‐11 trial showed better OS than patients in the HR‐03, mostly driven by a reduction of NRM.