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Effect of pediatric- versus adult-type chemotherapy regimens on outcomes of allogeneic hematopoietic stem cell transplants for adult T-cell acute lymphoblastic leukemia in first complete remission

Bone Marrow Transplantation volume 57, pages 1704–1711 (2022)Cite this article

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Abstract

The optimal chemotherapy regimen pre-transplantation for adult T-cell acute lymphoblastic leukemia (T-ALL) patients remains unknown. Here, we compared the transplant outcomes in 127 subjects receiving pediatric- (N = 57) or adult-type (N = 70) regimens pre-transplant. The corresponding 3-year cumulative incidences of relapse (CIR) was 7% (95% CI: 3–11%) and 29% (95% CI: 23–35%; P = 0.02), leukemia-free survivals (LFS) was 86% (95% CI: 81–91%) and 57% (95% CI: 51–63%; P = 0.003), overall survivals (OS) was 88% (95% CI: 84–92%) and 58% (95% CI: 52–64%; P = 0.002), the 1-year NRM was 4% (95% CI: 1–7%) and 9% (95% CI: 4–14%; P = 0.40). Multivariate analysis showed that pediatric-type regimen was associated with lower CIR (Hazard Ratio [HR] = 0.31 [95% CI: 0.09–1.00]; P = 0.05), better LFS (HR = 0.34 [95% CI: 0.15–0.78]; P = 0.01) and OS (HR = 0.30 [95% CI: 0.13–0.72]; P = 0.01). Our results suggested that adult T-ALL patients undergoing allo-HSCT might benefit from pediatric-type chemotherapy.

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Fig. 1: Outcomes in all subjects.
Fig. 2: Outcomes of subjects with MRD- at transplant.
Fig. 3: Outcomes of subjects with haploidentical transplantation.
Fig. 4: Sensitivity analyses for the associations between pediatric-type regimen and outcomes.

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Data availability

The data that support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

Profs. Tong-yu Lin, Zhi-ming Li, Qing-qing Cai, Zhong-jun Xia (Sun Yat-sen University Cancer Center) and Prof Xiao-dan Luo (The First Affiliated Hospital of Guangzhou Medical University) kindly referred subjects. Supported by the National Natural Science Foundation of China (Grants 81970161 and 82170163), Special Project for Research and Development in Key areas of Guangdong Province (Grant 2019B020236004), National Key Research and Development Projects (Grants 2017YFA0105500; 2017YFA0105501 and 2017YFA0105504), the Clinical Trial Funding of Southern Medical University(2016A020215112) and National Institute of Health Research (NIHR) Biomedical Research Centre funding scheme.

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  1. These authors contributed equally: Han-zhou Qi, Jun Xu, Qian-qian Yang.

Authors and Affiliations

  1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Han-zhou Qi, Jun Xu, Qian-qian Yang, Ren Lin, Zhi-xiang Wang, Ke Zhao, Qiang Wang, Xuan Zhou, Zhi-ping Fan, Fen Huang, Na Xu, Li Xuan, Hua Jin, Jing Sun, Hong-sheng Zhou & Qi-fa Liu

  2. Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK

    Robert Peter Gale

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Contributions

QFL, HSZ and RPG designed study. HZQ, JX, QQY, RL, KZ, QW, XZ, ZPF, FH, ZXW, NX and JS searched databases and processed analysis. HZQ, LX and HJ drafted the typescript. QFL, RPG, and HZQ revised the final typescript. QFL, HSZ and RPG are responsible for the paper.

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Correspondence to Hong-sheng Zhou or Qi-fa Liu.

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Qi, Hz., Xu, J., Yang, Qq. et al. Effect of pediatric- versus adult-type chemotherapy regimens on outcomes of allogeneic hematopoietic stem cell transplants for adult T-cell acute lymphoblastic leukemia in first complete remission. Bone Marrow Transplant 57, 1704–1711 (2022). https://doi.org/10.1038/s41409-022-01796-2

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