Clinical Reevaluation Of Allogeneic Hematopoietic Stem Cell Transplantation For Adults With Acute Lymphoblastic Leukemia In First Complete Remission

Objective: To evaluate the clinical efficacy of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of adult acute lymphoblastic leukemia(ALL)after the first complete remission(CR1),as well as the prognostic significance of adult ALL.Methods: The clinical data of 358 adult acute lymphoblastic leukemiapatients who achieved CR1 after induction therapy at Fujian Medical University Union Hospital from February 2012 to March 2018 were retrospectively analyzed.According to the treatment,the patients were divided into chemotherapy group(n=260)and allo-HSCT group(n=98).All patients were followed up to January 20,2019.The median follow-up time was 18.0(1.9-84.7)months.Disease-free survival(DFS),overall survival(OS),relapse rate(RR)and non-relapse mortality(NRM)were compared between the groups.Results: The median time from diagnosis to CR1 in all patients was 4(4 to 12)weeks.The DFS of 1,3,and 5 years were 58.3±2.6%,34.9±2.7%,and 32.3±2.8%,respectively,and the OS were 75.8±2.3%,40.7±2.9%,and 34.4±3.2%.The median DFS and OS time of the chemotherapy group were 15±1.6(95%CI:11.8-18.2)and 25.8±2.6(95%CI:20.7-30.9)months,and the allo-HSCT group were 24.7 and 29.1 months,respectively.The expected DFS of the 1,3,and 5 years in the chemotherapy group and allo-HSCT group were 46.5 vs 88.6,22.6 vs 67.2,20.4 vs 63.4 respectively(P<0.001),OS were 68.7 vs 93.9,27.3 vs 76.3,22.7vs 65.2(P<0.001)respectively.The allo-HSCT group showed better DFS and OS than the chemotherapy group.There were 155(59.6%)relapse cases in the chemotherapy group and 14(14.3%)in the allo-HSCT group.The expected RR of the 1,3,and 5 years in the chemotherapy group and allo-HSCT groupwere 45.0 vs 4.3,69.5 vs 18.2,71.5 vs 18.2,respectively.(P < 0.001).The relapse rate of the allo-HSCT group was significantly lower than that of the chemotherapy group.Of the 171(65.7%)deaths in the chemotherapy group,136(79.5%)died of relapse;of the23(23.5%)deaths in the allo-HSCT group,9(39.1%)died of relapse.The NRM in the allo-HSCT group was significantly higher than that in the chemotherapy group(P <0.001).Among the transplant patients,the transplant-related complications mainly included a GVHD(25,25.5%),c GVHD(10,10.2%),CMV Viremia(13,13.3%),and EBV Viremia(11,11.2%)hemorrhagic cystitis(21,21.4%),engraftment failure(1,1.0%).Multivariate analysis of prognosis showed that patients with high white blood cell counts at diagnosis had a poor prognosis,allo-HSCT HSCT was the only factor associated with improved OS,DFS and reduced RR in multivariate analysis.Conclusion: 1.Allo-HSCT significantly improves the long-term survival rate and reduce the relapse rate of adult ALL patients.2.Allo-HSCT is the first-line treatment for adult ALL-CR1 patients.