Evaluation of allogeneic transplantation in first or later minimal residual disease – negative remission following adult-inspired therapy for acute lymphoblastic leukemia

Abstract Comparisons without hematopoietic cell transplantation (HCT) to myeloablative (MAC) or reduced-intensity HCT (RIC) for adults with acute lymphoblastic leukemia (ALL) in first minimal-residual-disease negative remission (MRDNeg CR1) are limited. Further, the importance of MRDNeg following salvage therapy (MRDNeg CR2+) is unknown. We evaluated 89 patients in MRDNeg CR1 after adult-inspired treatment: 33 received MAC (12 Philadelphia chromosome [Ph]+), 17 received RIC (13 Ph+), and 39 Deferred HCT (3 Ph+). Three-year overall survival (OS) estimates for MAC, RIC, and Deferred HCT were 71%, 69%, and 68%, while 3-year event-free survival (EFS) estimates were 65%, 54%, and 28%, respectively. Further, HCT in MRDNeg CR1 performed similarly to MRDNeg CR2+: 3-year OS estimates were 70% and 69%, and 3-year EFS estimates were 62% and 62%, respectively. In conclusion, adults with ALL in MRDNeg CR1 following adult-inspired therapy had similar OS with or without HCT, and HCT in MRDNeg CR2 + can yield long-term survival.

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