Allogeneic Hematopoietic Cell Transplantation Outcomes in Adolescents and Young Adults with Acute Lymphoblastic Leukemia

Strategic Insights -

A dual-center retrospective study of adolescents and young adults with acute lymphoblastic leukemia (ALL) who underwent allogeneic hematopoietic cell transplantation (HCT) in second remission (CR2) between 2010 and 2022 has been conducted. The study aimed to evaluate the outcomes of HCT in this patient population. The findings suggest that outcomes of HCT in CR2 are influenced by minimal residual disease (MRD) status and comorbidities, underscoring the need for risk-adapted transplant strategies.

Key Takeaways:

  • The study included 164 patients with a median age of 25 years, 66% of whom were male and 80% had B-ALL.
  • Frontline therapies included pediatric-inspired (54%) and hyperCVAD-based (33%) regimens, with most patients receiving myeloablative conditioning (74%) and being MRD-negative at HCT (67%).
  • At a median follow-up of 36 months, the 3-year overall survival (OS) and progression-free survival (PFS) were 53% and 46%, respectively.
  • The 3-year cumulative incidences of relapse and non-relapse mortality were 36% and 18%, respectively.
  • Chronic GVHD occurred in 27% of patients at 3 years, with 37% moderate and 25% severe.
  • On multivariable analysis, a HCT-specific comorbidity index 3 was independently associated with inferior OS, PFS, and higher non-relapse mortality.
  • MRD positivity predicted worse PFS and higher relapse risk but not OS.
  • The study concludes that outcomes of HCT in CR2 are influenced by MRD status and comorbidities, emphasizing the need for risk-adapted transplant strategies.

Statistics:

  • 164 patients were included in the study.
  • 25 years was the median age of the patients.
  • 54% of patients received pediatric-inspired regimens, while 33% received hyperCVAD-based regimens.
  • 74% of patients received myeloablative conditioning, and 67% were MRD-negative at HCT.
  • 3-year OS and PFS were 53% and 46%, respectively.
  • 3-year cumulative incidence of relapse was 36%.
  • 3-year cumulative incidence of non-relapse mortality was 18%.
  • Chronic GVHD occurred in 27% of patients at 3 years, with 37% moderate and 25% severe.

Sources:

  • Allogeneic Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults With Acute Lymphoblastic Leukemia-A Retrospective, Dual-Center Study. American Journal of Hematology, 2025.
  • Wiley, 111 River St, Hoboken 07030-5774, NJ, USA.
  • American Journal of Hematology can be contacted at: Wiley, 111 River St, Hoboken 07030-5774, NJ, USA. (Wiley-Blackwell - www.wiley.com/; American Journal of Hematology - onlinelibrary.wiley.com/journal/10.1002/(ISSN)1096-8652)