Adults with ALL Experience No Benefit of Consolidation Chemotherapy Prior to HCT

Consolidation chemotherapy does not benefit adults with acute lymphoblastic leukemia (ALL) who have a readily available donor and who undergo myeloablative allogeneic hematopoietic cell transplantation (HCT) in first complete remission (CR1), according to research presented at ASH.

In this retrospective study, Dr. Nelli Bejanyan of the University of Minnesota and colleagues analyzed outcomes of 524 adults with ALL in CR1 whose transplant outcomes were reported to the CIBMTR (Center for International Blood and Marrow Transplant Research). Patients underwent myeloabalative allogeneic HCT between 2008 and 2012 after receiving ≥2 cycles (n=109), or 1 cycle (n=93), or no (n=322) consolidation chemotherapy.

All three consolidation groups had similar patient, disease, and transplant characteristics, but patients who did not receive consolidation were older, took longer to achieve CR1 and less frequently received central nervous system prophylaxis or maintenance chemotherapy prior to HCT.

The table below details transplant outcomes at a median 59 months (range, 6-78) follow up of survivors.

Outcome≥2 cycles1-cycleNonep-value
3-year OS63%59%54%>0.3
3-year relapse20%27%22%>0.4
1-year TRM16%18%23%>0.4
3-year LFS54%48%47%>0.3
OS = overall survival, TRM = transplant-related mortality, LFS = leukemia-free survival

Consolidation did not influence risk of developing acute or chronic graft-versus-host disease (GVHD). A multivariable analysis adjusted for recipient age, Karnofsky performance status, time to CR1, graft source, donor type, and recipient cytomegalovirus serostatus confirmed that consolidation chemotherapy was not significantly associated with OS, relapse, TRM, or GVHD.

The researchers concluded that consolidation chemotherapy does not benefit adult ALL patients with a readily available donor who undergo myeloablative allogeneic HCT in CR1.

Bejanyan N, et al. Blood

Related Resources