Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission: An analysis by the Acute Leukemia Working Party of the EBMT

Sebastian Giebel; Myriam Labopin; Michael Potter; Xavier Poiré; Henrik Sengeloev; Gerard Socié; Anne Huynh; Boris V. Afanasyev; Urs Schanz; Olle Ringden; Peter Kalhs; Dietrich W. Beelen; Antonio M. Campos; Tamás Masszi; Jonathan Canaani; Mohamad Mohty; Arnon Nagler

doi:10.1016/j.ejca.2018.03.018

Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission: An analysis by the Acute Leukemia Working Party of the EBMT

Sebastian Giebel^*, Myriam Labopin, Michael Potter, Xavier Poiré, Henrik Sengeloev, Gerard Socié, Anne Huynh, Boris V. Afanasyev, Urs Schanz, Olle Ringden, Peter Kalhs, Dietrich W. Beelen, Antonio M. Campos, Tamás Masszi, Jonathan Canaani, Mohamad Mohty, Arnon Nagler

^*Corresponding author for this work

Department of Clinical Medicine

12 Citations (Scopus)

Abstract

Background: Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome–positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs). Methods: We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014. Results: In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)–based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01). Conclusion: In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.

Original language	English
Journal	European Journal of Cancer
Volume	96
Pages (from-to)	73-81
Number of pages	9
ISSN	0959-8049
DOIs	https://doi.org/10.1016/j.ejca.2018.03.018
Publication status	Published - 2018

Keywords

AlloHSCT
AutoHSCT
GvHD
Minimal residual disease
Ph-positive ALL
Tyrosine kinase inhibitors

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Giebel, S., Labopin, M., Potter, M., Poiré, X., Sengeloev, H., Socié, G., Huynh, A., Afanasyev, B. V., Schanz, U., Ringden, O., Kalhs, P., Beelen, D. W., Campos, A. M., Masszi, T., Canaani, J., Mohty, M., & Nagler, A. (2018). Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission: An analysis by the Acute Leukemia Working Party of the EBMT. European Journal of Cancer, 96, 73-81. https://doi.org/10.1016/j.ejca.2018.03.018

Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission : An analysis by the Acute Leukemia Working Party of the EBMT. / Giebel, Sebastian; Labopin, Myriam; Potter, Michael et al.

In: European Journal of Cancer, Vol. 96, 2018, p. 73-81.

Research output: Contribution to journal › Journal article › Research › peer-review

Giebel, S, Labopin, M, Potter, M, Poiré, X, Sengeloev, H, Socié, G, Huynh, A, Afanasyev, BV, Schanz, U, Ringden, O, Kalhs, P, Beelen, DW, Campos, AM, Masszi, T, Canaani, J, Mohty, M & Nagler, A 2018, 'Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission: An analysis by the Acute Leukemia Working Party of the EBMT', European Journal of Cancer, vol. 96, pp. 73-81. https://doi.org/10.1016/j.ejca.2018.03.018

Giebel S, Labopin M, Potter M, Poiré X, Sengeloev H, Socié G et al. Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission: An analysis by the Acute Leukemia Working Party of the EBMT. European Journal of Cancer. 2018;96:73-81. doi: 10.1016/j.ejca.2018.03.018

Giebel, Sebastian ; Labopin, Myriam ; Potter, Michael et al. / Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission : An analysis by the Acute Leukemia Working Party of the EBMT. In: European Journal of Cancer. 2018 ; Vol. 96. pp. 73-81.

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title = "Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission: An analysis by the Acute Leukemia Working Party of the EBMT",

abstract = "Background: Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome–positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs). Methods: We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014. Results: In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)–based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01). Conclusion: In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.",

keywords = "AlloHSCT, AutoHSCT, GvHD, Minimal residual disease, Ph-positive ALL, Tyrosine kinase inhibitors",

author = "Sebastian Giebel and Myriam Labopin and Michael Potter and Xavier Poir{\'e} and Henrik Sengeloev and Gerard Soci{\'e} and Anne Huynh and Afanasyev, {Boris V.} and Urs Schanz and Olle Ringden and Peter Kalhs and Beelen, {Dietrich W.} and Campos, {Antonio M.} and Tam{\'a}s Masszi and Jonathan Canaani and Mohamad Mohty and Arnon Nagler",

year = "2018",

doi = "10.1016/j.ejca.2018.03.018",

language = "English",

volume = "96",

pages = "73--81",

journal = "European Journal of Cancer, Supplement",

issn = "0959-8049",

publisher = "Pergamon",

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TY - JOUR

T1 - Comparable results of autologous and allogeneic haematopoietic stem cell transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia in first complete molecular remission

T2 - An analysis by the Acute Leukemia Working Party of the EBMT

AU - Giebel, Sebastian

AU - Labopin, Myriam

AU - Potter, Michael

AU - Poiré, Xavier

AU - Sengeloev, Henrik

AU - Socié, Gerard

AU - Huynh, Anne

AU - Afanasyev, Boris V.

AU - Schanz, Urs

AU - Ringden, Olle

AU - Kalhs, Peter

AU - Beelen, Dietrich W.

AU - Campos, Antonio M.

AU - Masszi, Tamás

AU - Canaani, Jonathan

AU - Mohty, Mohamad

AU - Nagler, Arnon

PY - 2018

Y1 - 2018

N2 - Background: Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome–positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs). Methods: We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014. Results: In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)–based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01). Conclusion: In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.

AB - Background: Allogeneic haematopoietic stem cell transplantation (alloHSCT) is considered a standard treatment for patients with Philadelphia chromosome–positive acute lymphoblastic leukaemia (Ph+ ALL) achieving complete remission after induction containing tyrosine kinase inhibitors (TKIs). Methods: We retrospectively compared results of myeloablative alloHSCT from either matched sibling donor (MSD) or unrelated donor (URD) with autologous (auto) HSCT for adults with Ph+ ALL in molecular remission, treated between 2007 and 2014. Results: In univariate analysis, the incidence of relapse at 2 years was 47% after autoHSCT, 28% after MSD-HSCT and 19% after URD-HSCT (P = 0.0002). Respective rates of non-relapse mortality were 2%, 18%, and 22% (P = 0.001). The probabilities of leukaemia-free survival were 52%, 55% and 60% (P = 0.69), while overall survival rates were 70%, 70% and 69% (P = 0.58), respectively. In multivariate analysis, there was a trend towards increased risk of overall mortality after MSD-HSCT (hazard ratio [HR], 1.5, P = 0.12) and URD-HSCT (HR, 1.6, P = 0.08) when referred to autoHSCT. The use of total body irradiation (TBI)–based regimens was associated with reduced risk of relapse (HR, 0.65, P = 0.02) and overall mortality (HR, 0.67, P = 0.01). Conclusion: In the era of TKIs, outcomes of myeloablative autoHSCT and alloHSCT for patients with Ph+ ALL in first molecular remission are comparable. Therefore, autoHSCT appears to be an attractive treatment option potentially allowing for circumvention of alloHSCT sequelae. Irrespective of the type of donor, TBI-based regimens should be considered the preferable type of conditioning for Ph+ ALL.

KW - AlloHSCT

KW - AutoHSCT

KW - GvHD

KW - Minimal residual disease

KW - Ph-positive ALL

KW - Tyrosine kinase inhibitors

U2 - 10.1016/j.ejca.2018.03.018

DO - 10.1016/j.ejca.2018.03.018

M3 - Journal article

C2 - 29679774

AN - SCOPUS:85045673193

SN - 0959-8049

VL - 96

SP - 73

EP - 81

JO - European Journal of Cancer, Supplement

JF - European Journal of Cancer, Supplement

ER -