Allogeneic Hematopoietic Cell Transplantation (HCT) for Adult T-Cell Acute Lymphoblastic Leukemia (T-ALL).

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (2017)

Abstract:

Allogeneic hematopoietic cell transplantation (HCT) is recommended for T-cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission (CR) and in high risk patients in first CR. Given its relative rarity, data on outcomes of HCT for T-ALL are limited. We conducted a multi-center retrospective cohort study using data from 208 adult patients transplanted from 2000-2014 to describe outcomes of allogeneic HCT for T-ALL in the contemporary era. Median age at HCT was 37 years and the majority of patients were transplanted in CR, using total body irradiation (TBI) based myeloablative conditioning regimens. One-quarter of patients received alternative donor HCT using mis-matched, umbilical cord blood or haploidentical donors. With a median follow up of 38 months, overall survival at 5-years was 34%. The corresponding cumulative incidence of non-relapse mortality and relapse was 26% and 41%, respectively. In multivariable analysis, factors significantly associated with overall survival were the use of TBI (HR 0.57, P=0.021), age >35 (HR 1.55, P=0.025), and disease status at transplantation (HR 1.98, P=0.005 for relapsed/refractory disease compared to CR). Relapse was the most common cause of death (58% patients). Allogeneic HCT remains a potentially curative option in selected patients with adult T-ALL, although relapse is a major cause of treatment failure.