Journal: American journal of hematology
This dual-center retrospective study evaluated survival outcomes for adolescents and young adults (ages 15-40) with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic cell transplantation (HCT) in second remission (CR2) between 2010 and 2022.
Among 164 patients (median age 25; 80% B-ALL):
- 54% received pediatric-inspired regimens.
- 33% received hyperCVAD before transplant.
- Most underwent myeloablative conditioning.
- 67% were minimal residual disease (MRD)-negative at HCT.
At a median follow-up of 36 months:
- 3-year overall survival was 53%.
- Progression-free survival was 46%.
- Relapse rate at 3 years was 36%.
- Non-relapse mortality was 18%.
Graft-versus-host disease (GVHD) rates included:
- Acute grade 2-4 GVHD occurred in 36%.
- Chronic GVHD occurred in 27%.
Key predictors of outcomes were:
- Higher HCT-specific comorbidity index (>3) independently predicted worse survival and increased non-relapse mortality.
- MRD positivity was associated with poorer progression-free survival and higher relapse risk.
These findings support HCT in CR2 as a curative option for AYA ALL patients. They highlight the impact of MRD status and comorbidities on outcomes and emphasize the importance of risk-adapted transplant approaches.