Universität zu Köln

Bazarbachi, Abdul Hamid, Labopin, Myriam, Kroger, Nicolaus, Brecht, Arne, Blaise, Didier, Clausen, Johannes, Fanin, Renato, Einsele, Herman, Cavanna, Luigi, Itala-Remes, Maija, Bulabois, Claude Eric, Kundgen, Lukas, Martin, Hans, Schmid, Christof, Wagner-Drouet, Eva Maria, Alakel, Nael, Bazarbachi, Ali, Savani, Bipin, Nagler, Arnon and Mohty, Mohamad (2021). Predictive Factors for Outcome of First Allogeneic Transplant for Elderly Patients With Acute Lymphoblastic Leukemia. Clin. Lymphoma Myeloma Leuk., 21 (12). S. 831 - 841. DALLAS: CIG MEDIA GROUP, LP. ISSN 2152-2669

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Abstract

Acute lymphoblastic leukemia (ALL) in elderly patients is challenging, and while allogeneic stem cell transplantation (alloHCT) has established benefits in younger candidates, its use in the elderly can be difficult. We identified 84 ALL patients 70 years or older in the EBMT registry that underwent alloHCT. Our results demonstrate favorable outcome especially in those achieving first complete remission with >50% 2-year OS. AlloHCT appears feasible in select elderly ALL patients. Introduction/Background: The treatment of acute lymphoblastic leukemia (ALL) in patients older than 70 is extremely challenging with dismal outcome. Allogeneic stem cell transplantation (alloHCT) has seen many advancements in the last decades showing benefits in younger ALL patients, but this treatment modality is decreasingly used with increasing age due to high treatment-related mortality. Patients and Methods: We identified 84 ALL patients 70 to 84 years old allografted In 2002 to 2019 from a matched related (23%), unrelated (58%), haploidentical (17%), or cord blood (2%) donor at EBMT participating centers with a median follow-up of 23 months. Results: The 2-year relapse incidence (RI) and non-relapse mortality were 37% and 28%, respectively, and 2-year leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were 35%, 39% and 23%, respectively. The strongest predictor of outcome was disease status at transplant whereby patients in first complete remission (CR1) had >50% 2-year OS, reflected in multivariate analysis (MVA) with significant improvement in RI, LFS, and GRFS (HR 0.23, 0.49, and 0.54, respectively). Furthermore, karnofsky score >= 90 reflective of good functional status positively influenced non-relapse mortality in both univariate and MVA (HR 0.37), and interestingly, donor CMV positivity appeared to negatively affect RI, LFS and OS in univariate analysis and RI in MVA (HR 2.87). Conclusion: Our data suggest that alloHCT is an option for elderly ALL patients, particularly those carefully selected and transplanted in CR1 especially if failed or without access to novel non-chemotherapy-based approaches. (C) 2021 Elsevier Inc. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bazarbachi, Abdul Hamid UNSPECIFIED UNSPECIFIED UNSPECIFIED Labopin, Myriam UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroger, Nicolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Brecht, Arne UNSPECIFIED UNSPECIFIED UNSPECIFIED Blaise, Didier UNSPECIFIED UNSPECIFIED UNSPECIFIED Clausen, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Fanin, Renato UNSPECIFIED UNSPECIFIED UNSPECIFIED Einsele, Herman UNSPECIFIED UNSPECIFIED UNSPECIFIED Cavanna, Luigi UNSPECIFIED UNSPECIFIED UNSPECIFIED Itala-Remes, Maija UNSPECIFIED UNSPECIFIED UNSPECIFIED Bulabois, Claude Eric UNSPECIFIED UNSPECIFIED UNSPECIFIED Kundgen, Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED Martin, Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmid, Christof UNSPECIFIED UNSPECIFIED UNSPECIFIED Wagner-Drouet, Eva Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Alakel, Nael UNSPECIFIED UNSPECIFIED UNSPECIFIED Bazarbachi, Ali UNSPECIFIED UNSPECIFIED UNSPECIFIED Savani, Bipin UNSPECIFIED UNSPECIFIED UNSPECIFIED Nagler, Arnon UNSPECIFIED UNSPECIFIED UNSPECIFIED Mohty, Mohamad UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-605816
DOI:	10.1016/j.clml.2021.07.010
Journal or Publication Title:	Clin. Lymphoma Myeloma Leuk.
Volume:	21
Number:	12
Page Range:	S. 831 - 841
Date:	2021
Publisher:	CIG MEDIA GROUP, LP
Place of Publication:	DALLAS
ISSN:	2152-2669
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LOW-INTENSITY CHEMOTHERAPY; STEM-CELL TRANSPLANTATION; FRONT-LINE TREATMENT; VERSUS-HOST-DISEASE; OLDER-ADULTS; COMPLETE REMISSION; REDUCED INTENSITY; WORKING PARTY; FOLLOW-UP; PHASE-2 Multiple languages Oncology; Hematology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/60581