Cecilia Brown

Cancer Nursing Today nonprod

Extensive chronic graft-versus-host disease (GVHD) occurred in 15% of patients with acute lymphoblastic leukemia (ALL) within 2 years of undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in their first complete remission.Martina Calabr&ograve;, MD, of Federico II University of Naples, and colleagues conducted the study to identify risk factors influencing allogeneic HSCT outcomes in patients with ALL who received a transplant between 2015 and 2021. Dr. Calabr&ograve; and colleagues presented the results at the 64th American Society of Hematology Annual Meeting and Exposition.The researchers identified 2349 patients with ALL who received a transplant, including 870 who received a transplant from a human leukocyte antigen (HLA)-matched sibling donor. However, 1150 of the patients received a transplant from an unrelated donor, with 79% being a 10/10 match and 21% being a 9/10 match. They also identified 329 patients who received a transplant from a haploidentical donor. Peripheral blood was the stem cell source in 85.3% patients. Most patients (79%) received myeloablative conditioning, and the remaining patients received reduced intensity conditioning.Most patients (56.4%) had Philadelphia chromosome positive B-cell ALL, 28.4% had Philadelphia chromosome negative B-cell ALL, and 15.2% had T-cell ALL. The median time from diagnosis to transplant was 5.8 months.The cumulative incidence of grade II-IV acute GVHD at 180 days was 29.2%. The cumulative incidence of grade III-IV acute GVHD was 10.1% at that time point.The 2-year overall rate of chronic GVHD was 34%, and the 2-year overall rate of extensive chronic GVHD was 15%. The 2-year GVHD-free/relapse-free survival rate was 48%.The 2-year leukemia-free survival rate was 62.3%, and the 2-year overall survival rate was 73.9%. The 2-year relapse incidence was 22.2%, and the 2-year nonrelapse mortality rate was 15.4%.Having a matched sibling donor was significantly associated with a lower risk of grade II-IV acute GVHD compared with having a 9/10 (hazard ratio [HR], 0.58; 95% CI, 0.44-0.78; P&lt;.01) or 10/10 matched unrelated donor (HR, 0.70; 95% CI, 0.56-0.87; P&lt;.01).Total body irradiation was significantly associated with a higher risk of grade II-IV acute GVHD (HR, 1.54; 95% CI, 1.23-1.92; P&lt;.01) and chronic GVHD (HR, 1.47; 95% CI, 1.16-1.87; P&lt;.01) compared with chemotherapy. However, total body irradiation was also significantly associated with lower relapse incidence (HR, 0.78; 95% CI, 0.61-0.99; P=.04) and higher rates of leukemia-free survival (HR, 0.80; 95% CI, 0.67-0.96; P&lt;.02).Use of peripheral blood stem cells was independently associated with a higher risk of chronic GVHD, as was the use of a female donor to male recipient.&ldquo;Use of [total body irradiation] and HLA mismatches are both associated with lower [relapse incidence] despite a higher risk of GVHD, highlighting the importance of tailoring GVHD prophylaxis in these settings,&rdquo; Dr. Calabr&ograve; and colleagues concluded.Calabr&ograve; M, Labopin M, Battipaglia G, et al. Risk factors influencing transplant outcomes of adults with acute lymphoblastic leukemia in first complete remission: a retrospective analysis from the ALWP of the EBMT. Abstract #2124. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.

GVHD Outcomes in Patients With ALL After Allogeneic HSCT

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Extensive chronic GVHD occurred in 15% of patients with ALL within 2 years of undergoing allogeneic HSCT in their first complete remission.