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<p>The role of allogeneic hematopoietic cell transplantation (allo-HCT) in older patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) is not well established. In this retrospective analysis we evaluated outcomes of 566 patients with median age of 60 (range 55–76) years treated in first complete remission with allo-HCT from either a matched sibling (<i>n</i> = 138), unrelated (<i>n</i> = 343) or haploidentical (<i>n</i> = 85) donor between the years 2016 and 2022. The probability of overall survival (OS) and leukemia-free survival (LFS) at 2 years was 71% and 59.5%, respectively. The incidence of relapse, and non-relapse mortality (NRM) was 18% and 22.5%, respectively. The rate of graft-versus-host disease (GVHD)-free, relapse-free survival was 50%. In a multivariate model, the use of total body irradiation (TBI) was the only factor affecting outcomes, being associated with reduced risk of NRM (hazard ratio, [HR] = 0.46, <i>p</i> = 0.004), improved LFS (HR = 0.53, <i>p</i> &lt; 0.001) and OS (HR = 0.47, <i>p</i> &lt; 0.001) as well as increased risk of chronic GVHD (HR = 1.68, <i>p</i> = 0.009) and extensive chronic GVHD (HR = 1.84, <i>p</i> = 0.04). We conclude that in the last few years, outcomes of allo-HCT for patients with Ph+ ALL aged ≥55 years are encouraging. TBI-based reduced intensity conditioning appears preferable in this patient population. Our data can serve as a reference for future prospective trials.</p>

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Allogeneic hematopoietic cell transplantation for older patients with Philadelphia-positive acute lymphoblastic leukemia. A study by the Acute Leukemia Working Party of the EBMT

  • 期刊论文

  • 发表日期：

    2025年7月16日

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  • Sebastian Giebel,
  • Myriam Labopin,
  • Ryszard Swoboda,
  • Didier Blaise,
  • Ibrahim Yakoub-Agha,
  • Stephanie Nguyen,
  • Eva Maria Wagner-Drouet,
  • Cristina Castilla-Llorente,
  • Panagiotis Kottaridis,
  • Thomas Schroeder,
  • Renato Fanin,
  • Jakob Passweg,
  • Jurjen Versluis,
  • Charles Crawley,
  • Ludovic Gabellier,
  • Stephan Mielke,
  • Xavier Poiré,
  • Erfan Nur,
  • Carlos Pinho Vaz,
  • Matthias Eder,
  • Chiara Nozzoli,
  • Peter Dreger,
  • Zinaida Peric,
  • Mohamad Mohty,
  • Fabio Ciceri

摘要

The role of allogeneic hematopoietic cell transplantation (allo-HCT) in older patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) is not well established. In this retrospective analysis we evaluated outcomes of 566 patients with median age of 60 (range 55–76) years treated in first complete remission with allo-HCT from either a matched sibling (n = 138), unrelated (n = 343) or haploidentical (n = 85) donor between the years 2016 and 2022. The probability of overall survival (OS) and leukemia-free survival (LFS) at 2 years was 71% and 59.5%, respectively. The incidence of relapse, and non-relapse mortality (NRM) was 18% and 22.5%, respectively. The rate of graft-versus-host disease (GVHD)-free, relapse-free survival was 50%. In a multivariate model, the use of total body irradiation (TBI) was the only factor affecting outcomes, being associated with reduced risk of NRM (hazard ratio, [HR] = 0.46, p = 0.004), improved LFS (HR = 0.53, p < 0.001) and OS (HR = 0.47, p < 0.001) as well as increased risk of chronic GVHD (HR = 1.68, p = 0.009) and extensive chronic GVHD (HR = 1.84, p = 0.04). We conclude that in the last few years, outcomes of allo-HCT for patients with Ph+ ALL aged ≥55 years are encouraging. TBI-based reduced intensity conditioning appears preferable in this patient population. Our data can serve as a reference for future prospective trials.