Терапевтический архив (Jul 2015)

Autologous hematopoietic stem cell transplantation as late high-dose consolidation in adult patients with T-cell lymphoblastic leukemias: Results of a Russian multicenter study

  • E N Parovichnikova,
  • L A Kuzmina,
  • L P Mendeleeva,
  • G A Klyasova,
  • V V Troitskaya,
  • A N Sokolov,
  • Z Kh Akhmerzaeva,
  • S K Kravchenko,
  • E O Gribanova,
  • E E Zvonkov,
  • S N Bondarenko,
  • O Yu Baranova,
  • T V Ryltsova,
  • L V Gavrilova,
  • E E Zinina,
  • A S Pristupa,
  • T S Kaporskaya,
  • N V Minaeva,
  • O S Samoilova,
  • T S Konstantinova,
  • V A Lapin,
  • K D Kaplanov,
  • I V Kryuchkova,
  • A S Nizamutdinova,
  • A V Klimovich,
  • E A Borisenkova,
  • V I Moskov,
  • T V Gaponova,
  • T V Obukhova,
  • I V Galtseva,
  • M A Rusinov,
  • S M Kulikov,
  • V G Savchenko

Journal volume & issue
Vol. 87, no. 7
pp. 15 – 25

Abstract

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Aim. To analyze the efficiency of the ALL-2009 protocol (ClinicalTrials.gov NCT01193933) in patients with T-cell leukemias, particularly the role of autologous hematopoietic stem cell transplantation (auto-HSCT) after non-myeloablative BEAM conditioning, followed by maintenance therapy. Subjects and methods. Since 2009, the ALL-2009 study has enrolled 90 patients with T-cell acute lymphoblastic leukemia (T-ALL), the treatment results were assessed in 86 patients: 6 and 28 patients underwent allogeneic HSCT and auto-HSCT, respectively. A landmark analysis was used to compare survival rates in patients who had undergone auto-HSCT and in those who had not. For this, the median time from complete remission to the date of auto-HSCT was determined (the median was 6 months). Then to compare with the auto-HSCT group, only 27 patients who had been in complete remission for 6 months or more were included in a chemotherapy group. Results. The achievement of complete remission in patients with thymic T-ALL (100%) was significantly higher than in those with early (85.7%) or mature (70%) variants. The patients with early and mature T-ALL as compared to those with thymic T-ALL showed high death rates in the remission induction (7.4 and 10% versus 0) and the patients with mature T-ALL had a higher proportion of refractory forms (20% versus 0). The 5-year overall and relapse-free survival rates in all the T-ALL patients were 66 and 76%, respectively. After auto-HSCT, the risk of recurrence was 0% versus 21% after chemotherapy (p=0.03). The relapse-free survival rates significantly differed in the auto-HSCT and non-auto-HSCT groups: 100 and 66%, respectively (p=0.047). Conclusion. The long-term survival rates obtained during this multicenter study in the T-ALL patients treated according to the ALL-2009 protocol, the basis for which is the principle of continuity of cytostatic effects, are exclusively optimistic. Late consolidation with auto-HSCT following non-myeloablative BEAM conditioning, followed by maintenance therapy, considerably reduces the risk of recurrence.

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