Intensification of pegaspargase in pretransplant chemotherapy regimens reduced relapse of adult Philadelphia chromosome-negative acute lymphoblastic leukemia after transplantation
10.3760/cma.j.cn421203-20210120-00037
- VernacularTitle:强化培门冬酶化学药物治疗方案降低成人费城染色体阴性ALL移植后复发
- Author:
Zhixiang WANG
1
;
Qiang WANG
;
Ren LIN
;
Xuan ZHOU
;
Zhiping FAN
;
Feng HUANG
;
Na XU
;
Pengcheng SHI
;
Hongsheng ZHOU
;
Qifa LIU
Author Information
1. 南方医科大学南方医院血液科，广州 510515
- Keywords:
Hematopoietic stem cell transplantation;
Acute lymphoblastic leukemia;
Chemotherapy
- From:
Chinese Journal of Organ Transplantation
2021;42(4):209-213
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore risk factors for relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adult Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia (Ph-ALL).Methods:A retrospective analysis was performed for 65 adult Ph-ALL patients undergoing initial allo-HSCT from 2016 to 2018. The effect of baseline level and treatment pre-transplantation for relapse after allo-HSCT was analyzed.Results:There were 37 males and 28 females with a median age of 25(14-58) years during allo-HSCT. And the median follow-up period was 27 months post-HSCT. The 2-year overall survival (OS) was 78.8%(95%CI 67.8%-89.8%) and the 2-year relapse-free survival (RFS) 70.7% (95%CI 58.2%-83.2%). Pre-transplant chemotherapy was offered for 3 to 7 courses and the median dose of polyethylene glycol-conjugated asparaginase (PEG-ASP) was 3 doses (2 000 IU/m 2 per dose). Multiariate analysis revealed that the regimen included more than 4 doses of PEG-ASP pre-HSCT (HR=4.067, P=0.046) was a protective factor for post-transplant relapse (HR=0.193, P=0.009). High-risk chromosome karyotype was a risk factor for relapse (HR=0.193, P=0.009). The 2-year RFS rate was 90.0%(95%CI 79.2%-100.0%) for intensive PEG-ASP group and 56.9%(95%CI 39.1%-74.7%) for control group ( P=0.01). No significant inter-group difference existed in overall survival (OS)( P=0.079). The 2-year OS was 90.6% (95%CI 80.4%-100.0%) in intensive PEG-ASP group and 72.1% (95%CI 56.6%-87.6%) in control group. Conclusions:For adult ph-ALL patients, a higher dose of PEG-ASP in pretransplant chemotherapy regimens may improve post-transplant RFS and achieve a better outcome.
