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Addition of BMT Not Indicated in Some With Peds Hypodiploid ALL

WEDNESDAY, Jan. 23, 2019 -- For some children with hypodiploid acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation does not improve outcomes compared with chemotherapy alone, according to a study published online Jan. 18 in the Journal of Clinical Oncology.

Ching-Hon Pui, M.D., from St. Jude Children's Research Hospital and the University of Tennessee Health Science Center in Memphis, and colleagues conducted a retrospective study involving 306 children with hypodiploid ALL enrolled in 16 cooperative study groups or institutions between 1997 and 2013.

The researchers found five-year event-free and overall survival rates of 55.1 and 61.2 percent, respectively, with a median follow-up of 6.6 years for the 272 evaluable patients. Correlations were seen for negative minimal residual disease (MRD) at the end of remission induction, high hypodiploidy with 44 chromosomes, and treatment in MRD-stratified protocols with favorable prognosis, with five-year event-free survival rates of 75, 74, and 62 percent, respectively. After exclusion of patients with high hypodiploidy with 44 chromosomes and adjustment for waiting time to transplant and covariables, there was no significant difference in disease-free survival between the 42 patients who underwent transplantation and the 186 who received chemotherapy only (P = 0.16); the estimated five-year survival rates were 59 and 51.5 percent, respectively. Compared with chemotherapy alone, transplantation produced no significant impact on outcome, especially among patients who achieved a negative MRD status on completion of remission induction.

"This study confirms our earlier observation that patients with hypodiploid ALL who have no evidence of minimal residual disease after remission induction therapy should not be transplanted," Pui said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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Posted: January 2019

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