(ChemotherapyAdvisor) – Patients with precursor B-cell acute lymphoblastic leukemia (B-ALL) who undergo myeloablative allogeneic hematopoietic cell transplantation (allo-HCT) after age 13 years have higher rates of transplant-related mortality (TRM) and lower survival rates than do younger patients, according to a retrospective single-institution study published in Biology of Blood and Marrow Transplantation.
Adolescent and young adult patients with B-ALL have “significantly inferior OS [overall survival] compared to children due to greater TRM,” reported a team led by Michael J. Burke, MD, at the University of Minnesota’s Pediatrics Division of Hematology/Oncology, in Minneapolis, Minnesota.
“(T)he allotransplant graft-versus-leukemia effect mediated relapse protection and provide rationale for investigations to identify new pre-transplant risk factors that may allocate older-age patients to allo-HCT in CR1 or CR2, rather than CR3 where outcomes are found to be significantly worse.”
Age ≥13 years at diagnosis is a high-risk factor for patients with B-ALL, but the role of age at time of transplant on outcome is not known. The authors reviewed allo-HCT outcomes among 136 patients who had been diagnosed at between ages 0 and 30 years, 79 (58%) of whom were age <13 years and 57 (42%) of whom were age 13 to 30 years.
Patients <13 years of age at allo-HCT had superior 5-year OS compared to adolescents and young adults (62% vs. 39%; P=0.03; Hazard Ratio [HR]=1.74; 95% CI, 1.04-2.95;P=0.03). In multivariate analyses, cumulative TRM at 1-year was higher among adolescents and young adults compared to children <13 years of age (28% vs. 14%; P=0.04). A trend was also identified between older age and higher TRM incidence (Risk Ratio [RR]=2.23; 95% CI, 1.01-4.9, P=0.05).
Graft source (marrow vs. umbilical cord blood), gender, and graft-versus-host disease status did not associate with TRM.
“Further improvements in peri-transplant care are needed to limit complications” in adolescent and young adult patients receiving allo-HCT for B-ALL, the authors wrote.