Abstract：
This PASS-ALL study was designed to explore the effect of paediatric-inspired versus adult chemotherapy regimens on survival of adolescents and young adults (AYA) with high-risk Philadelphia chromosome-negative B-cell acute lymphoblastic leukaemia (HR PH-ve B-cell ALL) eligible for allogeneic haematopoietic stem cell transplantation (allo-HSCT). The PASS-ALL study is a multicentre, observational cohort study, and 143 patients with HR B-cell PH-ve ALL were enrolled from five centres-77 patients allocated in the paediatric-inspired cohort and 66 in the adult cohort with comparable baseline characteristics. Of the 143 patients, 128 cases underwent allo-HSCT. Three-year leukaemia-free survival (LFS) in the paediatric-inspired cohort was 72.2% (95% CI 60.8%-83.6%) compared with 44.6% (95% CI 31.9%-57.3%; p = 0.001). Furthermore, time-to-positive minimal residual disease (TTP-MRD) post-HSCT was marked different, 3-year cumulative incidence of relapse was 25.9% (95% CI 15.8%-37.2%) in paediatric cohort and 45.4% (95% CI 40.0%-57.9%) in adult cohort (p = 0.026). Finally, the 3-year OS rate was 75.3% (95% CI 64.9%-85.7%) for the paediatric-inspired cohort and 64.1% (95% CI 51.8%-76.4%) for the adult cohort (p = 0.074). On a multivariate analysis, paediatric-inspired regimen is a predictive factor for LFS (HR = 2.540, 95% CI 1.327-4.862, p = 0.005). Collectively, our data suggest that paediatric-inspired chemotherapy pre-HSCT results in deeper and durable MRD response reduces relapse post-HSCT and improves survival in HR B-cell PH-ve ALL patients with allo-HSCT.
摘要：
这项PASS-ALL研究旨在探讨儿科启发与成人化疗方案对患有高危费城染色体阴性B细胞急性淋巴细胞白血病（HRPH-veB细胞ALL）的青少年和年轻人（AYA）的生存的影响符合异基因造血干细胞移植（allo-HSCT）的资格。PASS-ALL研究是一个多中心，观察性队列研究，从5个中心纳入了143例HRB细胞PH-veALL患者,其中77例患者在儿科启发队列中分配,66例患者在成人队列中分配,具有相当的基线特征.在143名患者中，128例患者行allo-HSCT。儿科启发队列的三年无白血病生存率（LFS）为72.2％（95％CI60.8％-83.6％），而为44.6％（95％CI31.9％-57.3％；p=0.001）。此外，HSCT后微小残留病阳性时间（TTP-MRD）明显不同，3年累积复发率在儿科队列中为25.9%（95%CI15.8%-37.2%），在成人队列中为45.4%（95%CI40.0%-57.9%）（p=0.026）。最后,儿科启发队列的3年OS率为75.3%(95%CI64.9%-85.7%),成人队列为64.1%(95%CI51.8%-76.4%)(p=0.074).在多变量分析中，儿科启发方案是LFS的预测因素(HR=2.540,95%CI1.327-4.862,p=0.005)。总的来说，我们的数据表明,HSCT前的儿科启发化疗可导致更深入和持久的MRD反应,从而减少HSCT后的复发,并提高allo-HSCT的HRB细胞PH-veALL患者的生存率.
