Optimal treatment for Philadelphia-negative acute lymphoblastic leukemia in first remission in the era of high-intensity chemotherapy

• Published in: International journal of hematology 2021-11, Vol.114 (5), p.608-619
• Main Authors: Kako, Shinichi, Hayakawa, Fumihiko, Imai, Kiyotoshi, Tanaka, Junji, Mizuta, Shuichi, Nishiwaki, Satoshi, Kanamori, Heiwa, Mukae, Junichi, Ozawa, Yukiyasu, Kondo, Tadakazu, Fukuda, Takahiro, Ichinohe, Tatsuo, Ota, Shuichi, Tanaka, Yoshinori, Murayama, Tohru, Kurahashi, Shingo, Sakura, Toru, Usui, Noriko, Ohtake, Shigeki, Kiyoi, Hitoshi, Matsumura, Itaru, Miyazaki, Yasushi, Atsuta, Yoshiko
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Adult; Aged; Aged, 80 and over; Antigens; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Clinical Decision-Making; Combined Modality Therapy; Disease Management; Female; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Histocompatibility antigen HLA; Histocompatibility Testing; Humans; Leukemia; Leukocytes; Lymphatic leukemia; Male; Medicine; Medicine & Public Health; Middle Aged; Mud; Oncology; Original Article; Patients; Philadelphia chromosome; Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - etiology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Prognosis; Remission; Remission (Medicine); Remission Induction; Stem cell transplantation; Stem cells; Survival Analysis; Transplantation; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-021-03198-4

The optimal treatment for Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1) has not been established in the high-intensity chemotherapy era. The outcomes of patients with Ph-negative ALL who underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a human leukocyte antigen-matched related or unrelated donor in CR1 (HSCT-MRD group and HSCT-MUD group) were obtained from a Japanese registry database. Patients aged 16–24 years and 25–65 years were analyzed separately, and their outcomes were compared to those of patients who continued high-intensity chemotherapy in CR1 in studies (202U group and 202O group) by the Japan Adult Leukemia Study Group (JALSG). In the HSCT-MRD group, patients younger than 25 years had lower overall survival (OS) than the 202U group, presumably due to the higher non-relapse mortality (NRM) in the HSCT-MRD group. Patients 25 years and older had similar OS to the 202O group. The lower relapse rate was counterbalanced by higher NRM in the HSCT-MRD group. In the HSCT-MUD group, patients in both age groups had similar OS to their corresponding groups in the JALSG studies. In conclusion, high-intensity chemotherapy may change the role of HSCT for Ph-negative ALL.