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Researchers from Stanford University School of Medicine observed overall survival among patients with acute lymphoblastic leukemia (ALL) who relapsed following hematopoietic cell transplant (HSCT) has increased in recent years. These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
Patients (N=285) who received HSCT for ALL between 2008 and 2019 were retrospectively analyzed for this study. They were stratified into early (2008-2013; n=119) and late (2014-2019; n=166) cohorts and clinical outcomes were compared.
Among all patients, 28% had a relapse of their leukemia following HSCT. Relapses occurred among 33% of the early and 25% of the late cohorts. The median time to relapse was 7.72 months (95% CI, 3.88-14.0).
Patients who experienced a relapse were 57% men, 47% were aged 18 to 39 years, 57% were in complete remission 1, and 49% received their tissue from matched siblings. Patients who relapsed in the late cohort were less likely to receive their transplant during active disease (2% vs 26%; P =.008).
Following relapse, overall survival was 7.99 months (95% CI, 3.30-11.6) among the early cohort and 15.75 months (95% CI, 9.24-26.4; P <.0001) among the late group, which was a near doubling of overall survival over time.
Patients who relapsed during the late era were less likely to receive chemotherapy (38% vs 70%; P <.001) or receive no therapy (10% vs 18%) and more likely to receive novel therapies (44% vs 3%). The novel therapies were blinatumomab (64%), inotuzumab (41%), chimeric antigen receptor T cells (36%), and 8 patients received at least 2 novel therapies. In total, 2 patients were given a second HSCT.
These data were limited by difference of disease stage at HSCT, which may have impacted the survival rates. The study was too underpowered to relate significant differences with the specific novel therapeutics.
The study authors concluded there was a trend of increased survival following HSCT among patients with ALL in recent years. Juliana Craig, BA, coauthor of the study, speculated that the improved survival “is likely influenced by the use of targeted amino therapies to treat posttransplant relapse, which has also increased dramatically since 2014. Although these data represent an improvement, relative to historical outcomes, post transplant relapse remains an area of ongoing need among adults with ALL.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Craig J, Iglesias M, Cunanan K, et al. Survival following post-HCT relapse in adult acute lymphoblastic leukemia has improved in the era of novel immunotherapies: a single institution analysis. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 495.