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1822 Two-Year Landmark Survival Analysis after Allogeneic Hematopoietic Cell Transplantation in Acute Lymphoblastic Leukemia: An Analysis from the ALWP of the EBMT

Program: Oral and Poster Abstracts
Session: 723. Allogeneic Transplantation: Long-term Follow-up and Disease Recurrence: Poster I
Hematology Disease Topics & Pathways:
Clinically Relevant, Clinical Practice (e.g. Guidelines, Health Outcomes and Services, and Survivorship, Value; etc.)
Saturday, December 11, 2021, 5:30 PM-7:30 PM

Vivek Patel, MD1, Myriam Labopin2*, Thomas Schroeder, MD3*, Igor Wolfgang Blau, MD4*, Lars Klingen Gjaerde, MD5*, Mahmoud Aljurf6, Gérard Socié, MD, PhD7*, Urpu Salmenniemi, MD8*, Wolfgang A Bethge9*, Jakob Passweg, MD10*, Marie Balsat, MD11*, Emma Nicholson, MD, PhD12*, Johanna Tischer, MD13*, Sebastian Giebel, MD, PhD14*, Zinaida Peric, MD, PhD15*, Eolia Brissot, MD, PhD16*, Bhagirathbhai Dholaria, MBBS1, Bipin Savani, MD17, Arnon Nagler, M.D.18,19 and Mohamad Mohty, MD, PhD20,21

1Vanderbilt University Medical Center, Nashville, TN
2EBMT Paris study office; Department of Haematology,, Saint Antoine Hospital; INSERM UMR 938, Sorbonne University, Paris, France
3Hematology, Uniklinik Dusseldorf, Duesseldorf, Germany
4Dept. Hematology, Oncology and Tumorimmunology, Campus Benjamin Franklin, Charité, Berlin, Berlin, Germany
5Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
6King Faisal Specialist Hospital & Research Centre, Oncology (Section of Adult Haematology/BMT), Riyadh, Saudi Arabia
7Assistance Publique Hôpitaux des Paris, Hématologie-Transplantation, Paris France and INSERM Unité Mixte de Recherche 976, Hôpital St. Louis, Université de Paris, Paris, France
8Stem Cell Transplantation Unit, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
9Hematology & Oncology, University of Tuebingen Medical Center, Tuebingen, Germany
10Hematology, University Hospital Basel, Basel, Switzerland
11Service Hematologie, Centre Hospitalier Lyon Sud, Lyon, France
12Department of Haematology/Bone marrow transplantation, The Royal Marsden NHS Foundation Trust, London, United Kingdom
13Department of Internal Medicine III, University Hospital München, München, -, Germany
14Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
15University Hospital Center Rebro, Zagreb, Croatia
16Department of Clinical Hematology and Cellular Therapy, Hopital Saint Antoine, Paris, France
17Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Houston, TX
18Division of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Israel
19Acute Leukemia Working Party of EBMT, Paris, France
20Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, Paris, France
21EBMT ALWP Office, Hopital Saint-Antoine, Paris, France

Background

Long-term survival and late mortality risk compared to general population for patients (pts) who underwent an allogeneic hematopoietic cell transplant (HCT) is unknown. We analyzed long-term outcomes of 2-year (yr) HCT survivors with acute lymphoblastic leukemia (ALL).

Methods

Adult pts with ALL who were alive and relapse-free at 2 yrs after first HCT from 2005-2012 were included. We excluded patients who had a cord blood transplant and ex vivo T cell depletion (TCD). Relative survival analysis was used to estimate HCT-related crude mortality taking into account for background population mortality rates of the general population, matched for age, sex, and country in the year of HCT (www.mortality.org).

Results

A total of 2701 pts were included with a median follow up interval of 99 months and median age of 34 (range 18 – 73.5) yrs. The majority (78.6%) of pts were in 1st complete remission (CR1) with undetectable MRD (68.3%). There were similar numbers of matched sibling donor (MSD) (43.7%) and unrelated donor transplants (MUD) (53.2%). Most pts received myeloablative conditioning (MAC) (86.5%) and peripheral blood (PB) grafts (75.7%) without in vivo TCD (55.7%).

The 10-yr probability for overall survival (OS) and leukemia-free survival (LFS) was 81.3% and 78.2%, respectively. Cumulative incidence of disease relapse and non-relapse mortality (NRM) at 10 years was 9.9% and 11.9%, respectively. The probability of chronic GVHD-relapse-free survival (cGRFS) at 10-yrs was 73.3% (Figure 1). Relapsed ALL and chronic GVHD were common causes of late mortality accounting for 33.9% and 29% of reported deaths, respectively, followed by infection and secondary malignancy. For patients transplanted in countries with available mortality data (92% of patients in our cohort), the probability of dying from another cause is negligible at 1.5% compared to the probability of dying from HCT (16.8%) 10 years after HCT (Figure 1F).

Conclusions

In a large registry-based study, we showed excellent long-term survival of 81.3% at 10-yr among the 2-yr survivors of HCT for ALL. There was no difference in long term outcomes with respect to conditioning intensity, but utilization of BM graft and in vivo TCD resulted in lower NRM, and better OS. Long-term mortality risk among HCT survivors remains significantly higher than expected for the general age-matched population.

Disclosures: Labopin: Jazz Pharmaceuticals: Honoraria. Schroeder: Celgene: Honoraria, Other: Travel support, Research Funding. Bethge: Miltenyi Biotec: Consultancy, Honoraria, Research Funding, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Kite-Gilead: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; Celgene: Consultancy, Honoraria, Speakers Bureau. Nicholson: Pfizer: Consultancy; BMS/Celgene: Consultancy; Kite, a Gilead Company: Other: Conference fees, Speakers Bureau; Novartis: Consultancy, Other: Conference fees. Giebel: Janssen: Honoraria, Speakers Bureau; Pfizer: Consultancy, Honoraria, Speakers Bureau; Novartis: Consultancy, Honoraria, Speakers Bureau; Amgen: Consultancy, Honoraria, Speakers Bureau. Peric: Therakos, Servier, MSD, Astellas, Novartis, Abbvie, Pfizer: Honoraria. Dholaria: Janssen: Research Funding; Pfizer: Research Funding; Takeda: Research Funding; Jazz: Speakers Bureau; MEI: Research Funding; Angiocrine: Research Funding; Poseida: Research Funding; Celgene: Speakers Bureau. Mohty: Sanofi: Honoraria, Research Funding; Pfizer: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Jazz: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Gilead: Honoraria; Celgene: Honoraria, Research Funding; Bristol Myers Squibb: Honoraria; Astellas: Honoraria; Amgen: Honoraria; Adaptive Biotechnologies: Honoraria.

*signifies non-member of ASH