Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study.
Fiche publication
Date publication
décembre 2016
Journal
Blood cancer journal
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BASTIE Jean-Noël, Dr LIOURE Bruno
Tous les auteurs :
Desjonquères A, Chevallier P, Thomas X, Huguet F, Leguay T, Bernard M, Bay JO, Tavernier E, Charbonnier A, Isnard F, Hunault M, Turlure P, Renaud M, Bastié JN, Himberlin C, Lepretre S, Lioure B, Lhéritier V, Asnafi V, Beldjord K, Lafage-Pochitaloff M, Béné MC, Ifrah N, Dombret H
Lien Pubmed
Résumé
The outcome of adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph- ALL) relapsing after pediatric-inspired front-line therapy is ill known. Here 229 relapsing Ph- ALL younger adults (18-63 years) treated within the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-2003/-2005 trials were considered. Salvage regimens consisted of potentially curative therapies in 194 cases, low-intensity therapies in 21, allogeneic stem cell transplant (allo-SCT) in 6 and best supportive care in 8. Overall, 77 patients received allo-SCT after relapse. The median follow-up was 3.1 years. A second complete remission (CR2) was achieved in 121 patients (53%). In multivariate analysis, only younger age <45 years (P=0.008) and CR1 duration ⩾18 months (P=0.009) predicted CR2. Overall survival (OS) at 2 and 5 years was 19.3% (14-24%) and 13.3% (8-18%), respectively. In CR2 patients, disease-free survival (DFS) at 2 and 5 years was 29.0% (21-38%) and 25% (17-33%). In multivariate analysis, CR1 duration ⩾18 months and allo-SCT after relapse were associated with longer DFS (P<0.009 and P=0.004, respectively) and longer OS (P=0.004 and P<0.0001, respectively). In conclusion, although younger adults relapsing after pediatric-inspired ALL therapies retain a poor outcome, some of them may be cured if CR1 duration ⩾18 months and if allo-SCT can be performed in CR2. New therapies are definitely needed for these patients.
Référence
Blood Cancer J. 2016 Dec;6(12):e504