Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study - Archive ouverte HAL Access content directly
Journal Articles Blood Cancer Journal Year : 2016

Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study

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A. Desjonqueres
  • Function : Author
T. Leguay
  • Function : Author
M. Bernard
  • Function : Author
J.O. Bay
  • Function : Author
J.N. Bastie
  • Function : Author
S. Lepretre
  • Function : Author
V. Lheritier
  • Function : Author
M. Lafage-Pochitaloff
  • Function : Author
M.C. Bene
  • Function : Author

Abstract

The outcome of adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph- ALL) relapsing after pediatric-inspired front-line therapy is ill known. Here 229 relapsing Ph- ALL younger adults (18-63 years) treated within the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-2003/-2005 trials were considered. Salvage regimens consisted of potentially curative therapies in 194 cases, low-intensity therapies in 21, allogeneic stem cell transplant (allo-SCT) in 6 and best supportive care in 8. Overall, 77 patients received allo-SCT after relapse. The median follow-up was 3.1 years. A second complete remission (CR2) was achieved in 121 patients (53%). In multivariate analysis, only younger age \textless45 years (P=0.008) and CR1 duration 18 months (P=0.009) predicted CR2. Overall survival (OS) at 2 and 5 years was 19.3% (14-24%) and 13.3% (8-18%), respectively. In CR2 patients, disease-free survival (DFS) at 2 and 5 years was 29.0% (21-38%) and 25% (17-33%). In multivariate analysis, CR1 duration 18 months and allo-SCT after relapse were associated with longer DFS (P\textless0.009 and P=0.004, respectively) and longer OS (P=0.004 and P\textless0.0001, respectively). In conclusion, although younger adults relapsing after pediatric-inspired ALL therapies retain a poor outcome, some of them may be cured if CR1 duration 18 months and if allo-SCT can be performed in CR2. New therapies are definitely needed for these patients

Dates and versions

hal-01792626 , version 1 (15-05-2018)

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A. Desjonqueres, P. Chevallier, X. Thomas, F. Huguet, T. Leguay, et al.. Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study. Blood Cancer Journal, 2016, 6, pp.e504. ⟨10.1038/bcj.2016.111⟩. ⟨hal-01792626⟩
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