This long-term, retrospective study of 601 adults with T-cell acute lymphoblastic leukemia (ALL) has demonstrated that hematopoietic cell transplantation (HCT) has better outcomes when total body irradiation (TBI) is used for pre-transplant conditioning compared to chemotherapy-only conditioning, but only in adults age <35 years. In the 405 patients under age 35, 5-year leukemia-free survival (LFS) was 50% when they were conditioned with a myeloablative TBI-based regimen compared to patients receiving a myeloablative chemotherapy-only regimen (18%) (p<0.0001). In a multivariate analysis, use of TBI was significantly associated with overall survival (HR=0.54 (0.34-0.87); p=0.01) and improved LFS (HR=0.55 (0.34-0.86); p=0.01) in patients age <35 years. The researchers concluded that younger adult patients with T-ALL undergoing myeloablative allogeneic HCT may benefit from TBI-based regimens.
Better HCT Outcomes in Younger Adults with T-Cell ALL