Stella Davide, Gill Jessica, Passera Roberto, Zompi Sofia, Dellacasa Chiara Maria, Audisio Ernesta, Cerrano Marco, Dogliotti Irene, Dicataldo Michele, Secreto Carolina, Bruno Benedetto, Freilone Roberto, Busca Alessandro, Giaccone Luisa
Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, 10126 Torino, Italy.
Stem Cell Transplant Center, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
Hematol Rep. 2024 Oct 17;16(4):636-647. doi: 10.3390/hematolrep16040062.
Despite the adoption of pediatric-like chemotherapy protocols, the introduction of new immunotherapies and a better understanding of the oncogenic landscape, the outcome for adult patients with acute lymphoblastic leukemia (ALL) remain substantially dismal. The aim of the present study was to evaluate the outcome in terms of survival in a cohort of adult patients with ALL who received allogeneic hematopoietic stem cell transplantation (alloSCT) between 2013 and 2023.
This was a single-center observational retrospective study including all consecutive adult patients with ALL who received an alloSCT between April 2013 and April 2023 at the Stem Cell Transplant Center AOU Città della Salute e della Scienza of Torino. The primary endpoints were overall survival (OS), graft-versus-host disease (GVHD) Relapse-Free Survival (GRFS), Leukemia-Free Survival (LFS) and cumulative incidence (CI) of Non-Relapse Mortality (NRM).
The 4-year OS and LFS were 63.4% and 48.1%, respectively, and the 1-year GRFS was 42.9%. The 1-year CI of bloodstream infections (BSI), invasive fungal infections and NRM were 38%, 7% and 18.4%, respectively. Multivariate analysis showed that the use of total body irradiation (TBI), a time interval from diagnosis to alloSCT 7 months and female gender were factors significantly associated with better OS. Relapse of the underlying malignancy and BSI were the main causes of death.
Our study suggests that alloSCT from a matched sibling donor (MSD) and alternative donors may be considered an effective tool for patients with ALL achieving a CR.
尽管采用了类似儿童的化疗方案、引入了新的免疫疗法并且对致癌格局有了更好的理解，但成年急性淋巴细胞白血病（ALL）患者的预后仍然相当糟糕。本研究的目的是评估2013年至2023年间接受异基因造血干细胞移植（alloSCT）的成年ALL患者队列的生存结局。
这是一项单中心观察性回顾性研究，纳入了2013年4月至2023年4月期间在都灵大学健康与科学城AOU干细胞移植中心接受alloSCT的所有连续成年ALL患者。主要终点为总生存期（OS）、移植物抗宿主病（GVHD）无复发生存期（GRFS）、无白血病生存期（LFS）以及非复发死亡率（NRM）的累积发生率（CI）。
4年OS和LFS分别为63.4%和48.1%，1年GRFS为42.9%。血流感染（BSI）、侵袭性真菌感染和NRM的1年CI分别为38%、7%和18.4%。多变量分析显示，使用全身照射（TBI）、从诊断到alloSCT的时间间隔≥7个月以及女性性别是与更好的OS显著相关的因素。潜在恶性肿瘤复发和BSI是主要死亡原因。
我们的研究表明，来自匹配同胞供体（MSD）和替代供体的alloSCT可能被认为是ALL达到完全缓解（CR）患者的有效治疗手段。
