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Acute Leukemia

Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes

Bone Marrow Transplantation volume 52, pages 20–27 (2017)Cite this article

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Abstract

This study aims to provide a detailed analysis of allogeneic stem cell transplantation (allo-SCT) outcomes in a large T-cell acute lymphoblastic leukemia (T-ALL) cohort with a specific emphasis on the effects of pre-transplant minimal residual disease (MRD) and disease subtype, including the aggressive early-thymic precursor (ETP) subtype. Data from 102 allo-SCT patients with a diagnosis of T-ALL from three centers were retrospectively analyzed. Patients were grouped into four T-ALL subtypes: ETP, early, cortical and mature. At 3 years, overall survival (OS), PFS, non-relapse mortality and cumulative incidence (CI) progression were 35, 33, 11 and 55%, respectively. Patients transplanted in first complete remission (CR1) had a 3-year OS of 62% versus those transplanted in CR2 or greater (24%) (hazards ratio 1.6, P=0.2). Patients with MRD positivity at the time of transplant had significantly higher rates of progression compared with those with MRD negativity (76 vs 34%, hazards ratio 2.8, P=0.006). There was no difference in OS, PFS or cumulative incidence (CI) progression between disease subtypes, including ETP (n=16). ETP patients transplanted in CR1 (n=10) had OS of 47%, comparable to other disease subtypes, suggesting that allo-SCT can overcome the poor prognosis associated with ETP. MRD status at transplant was highly predictive of disease relapse, suggesting novel therapies are necessary to improve transplant outcomes.

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Acknowledgements

We acknowledge William Dibb for his contributions to data collection and Guang Fan for her contributions regarding pathology data from OHSU. The authors have no source of income for this study to declare.

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Authors and Affiliations

  1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    J E Brammer, R M Saliba, C Ledesma, S Gaballa, R E Champlin, C Hosing & P Kebriaei

  2. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    J L Jorgensen

  3. National University Health System Singapore, Singapore

    M Poon

  4. Oregon Health & Science University, Knight Cancer Institute, Center for Hematologic Malignancies, Portland, OR, USA

    R T Maziarz

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  1. J E Brammer
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Correspondence to J E Brammer.

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Brammer, J., Saliba, R., Jorgensen, J. et al. Multi-center analysis of the effect of T-cell acute lymphoblastic leukemia subtype and minimal residual disease on allogeneic stem cell transplantation outcomes. Bone Marrow Transplant 52, 20–27 (2017). https://doi.org/10.1038/bmt.2016.194

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