Outcome for Children and Young Adults With T-Cell ALL and Induction Failure in Contemporary Trials
PURPOSE: Historically, patients with T-cell acute lymphoblastic leukemia (T-ALL) who fail to achieve remission at the end of induction (EOI) have had poor long-term survival. The goal of this study was to examine the efficacy of contemporary therapy, including allogeneic hematopoietic stem cell transplantation (HSCT) in first remission (CR1).
METHODS: Induction failure (IF) was defined as the persistence of at least 5% bone marrow (BM) lymphoblasts and/or extramedullary disease after 4-6 weeks of induction chemotherapy. Disease features and clinical outcomes were reported in 325 of 6,167 (5%) patients age 21 years and younger treated in 14 cooperative study groups between 2000 and 2018.
RESULTS: With a median follow-up period of 6.4 years (range, 0.3-17.9 years), the 10-year overall survival (OS) was 54.7% (SE = 2.9), which is significantly higher than the 27.6% (SE = 2.9) observed in the historical cohort from 1985 to 2000. There was no significant impact of sex, age, white blood cell count, central nervous system disease status, T-cell maturity, or BM disease burden at EOI on OS. Postinduction complete remission (CR) was achieved in 93% of patients with 10-year OS of 59.6% (SE = 3.1%) and disease-free survival (DFS) of 56.3% (SE = 3.1%). Among the patients who achieved CR, 72% underwent HSCT and their 10-year DFS (with a 190-day landmark) was significantly better than nontransplanted patients (63.8% [SE = 3.6] v 45.5% [SE = 7.1]; P = .005), with OS of 66.2% (SE = 3.6) versus 50.8% (SE = 6.8); P = .10, respectively.
CONCLUSION: Outcomes for patients age 21 years and younger with T-ALL and IF have improved in the contemporary treatment era with a DFS benefit among those undergoing HSCT in CR1. However, outcomes still lag considerably behind those who achieve remission at EOI, warranting investigation of new treatment approaches.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:41 |
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| Enthalten in: |
Journal of clinical oncology : official journal of the American Society of Clinical Oncology - 41(2023), 32 vom: 10. Nov., Seite 5025-5034 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Raetz, Elizabeth A [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 09.11.2023 Date Revised 16.11.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1200/JCO.23.00088 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359873618 |
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| 100 | 1 | |a Raetz, Elizabeth A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Outcome for Children and Young Adults With T-Cell ALL and Induction Failure in Contemporary Trials |
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| 500 | |a Date Revised 16.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: Historically, patients with T-cell acute lymphoblastic leukemia (T-ALL) who fail to achieve remission at the end of induction (EOI) have had poor long-term survival. The goal of this study was to examine the efficacy of contemporary therapy, including allogeneic hematopoietic stem cell transplantation (HSCT) in first remission (CR1) | ||
| 520 | |a METHODS: Induction failure (IF) was defined as the persistence of at least 5% bone marrow (BM) lymphoblasts and/or extramedullary disease after 4-6 weeks of induction chemotherapy. Disease features and clinical outcomes were reported in 325 of 6,167 (5%) patients age 21 years and younger treated in 14 cooperative study groups between 2000 and 2018 | ||
| 520 | |a RESULTS: With a median follow-up period of 6.4 years (range, 0.3-17.9 years), the 10-year overall survival (OS) was 54.7% (SE = 2.9), which is significantly higher than the 27.6% (SE = 2.9) observed in the historical cohort from 1985 to 2000. There was no significant impact of sex, age, white blood cell count, central nervous system disease status, T-cell maturity, or BM disease burden at EOI on OS. Postinduction complete remission (CR) was achieved in 93% of patients with 10-year OS of 59.6% (SE = 3.1%) and disease-free survival (DFS) of 56.3% (SE = 3.1%). Among the patients who achieved CR, 72% underwent HSCT and their 10-year DFS (with a 190-day landmark) was significantly better than nontransplanted patients (63.8% [SE = 3.6] v 45.5% [SE = 7.1]; P = .005), with OS of 66.2% (SE = 3.6) versus 50.8% (SE = 6.8); P = .10, respectively | ||
| 520 | |a CONCLUSION: Outcomes for patients age 21 years and younger with T-ALL and IF have improved in the contemporary treatment era with a DFS benefit among those undergoing HSCT in CR1. However, outcomes still lag considerably behind those who achieve remission at EOI, warranting investigation of new treatment approaches | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Rebora, Paola |e verfasserin |4 aut | |
| 700 | 1 | |a Conter, Valentino |e verfasserin |4 aut | |
| 700 | 1 | |a Schrappe, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Devidas, Meenakshi |e verfasserin |4 aut | |
| 700 | 1 | |a Escherich, Gabriele |e verfasserin |4 aut | |
| 700 | 1 | |a Imai, Chihaya |e verfasserin |4 aut | |
| 700 | 1 | |a De Moerloose, Barbara |e verfasserin |4 aut | |
| 700 | 1 | |a Schmiegelow, Kjeld |e verfasserin |4 aut | |
| 700 | 1 | |a Burns, Melissa A |e verfasserin |4 aut | |
| 700 | 1 | |a Elitzur, Sarah |e verfasserin |4 aut | |
| 700 | 1 | |a Pieters, Rob |e verfasserin |4 aut | |
| 700 | 1 | |a Attarbaschi, Andishe |e verfasserin |4 aut | |
| 700 | 1 | |a Yeoh, Allen |e verfasserin |4 aut | |
| 700 | 1 | |a Pui, Ching-Hon |e verfasserin |4 aut | |
| 700 | 1 | |a Stary, Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Cario, Gunnar |e verfasserin |4 aut | |
| 700 | 1 | |a Bodmer, Nicole |e verfasserin |4 aut | |
| 700 | 1 | |a Moorman, Anthony V |e verfasserin |4 aut | |
| 700 | 1 | |a Buldini, Barbara |e verfasserin |4 aut | |
| 700 | 1 | |a Vora, Ajay |e verfasserin |4 aut | |
| 700 | 1 | |a Valsecchi, Maria Grazia |e verfasserin |4 aut | |
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