T细胞急性淋巴细胞白血病(T-ALL)主要影响儿童晚期和成年期的个体。异基因造血干细胞移植(allo-HSCT)是一种治疗方式,特别是在低风险遗传和/或持续性微小残留疾病的情况下。有限的研究直接探讨了患者和移植相关因素对T-ALL移植后结果的影响。使用来自欧洲血液和骨髓移植协会注册的大型数据集,我们确定了1907名成年T-ALL患者(70%男性),他们在第一次完全缓解(CR1)中接受了来自匹配同胞供体(MSD;45%)的第一次allo-HSCT,在2010年至2021年之间,不相关的捐赠者(UD;43%)或单倍体捐赠者(12%)。移植的中位年龄为33.4岁(18.1-75岁)。中位随访时间为2.9年。大多数患者接受了基于全身照射(TBI)的清髓性预处理(69%)。2年总生存率(OS)为69.4%,无白血病生存率(LFS)为62.1%。在多变量分析中,移植时的高龄对LFS产生负面影响(每增加10年,HR=1.11,p=0.004),无GVHD,无复发生存率(GRFS)(HR=1.06,p=0.04),OS(HR=1.12,p=0.002),和非复发死亡率(NRM)(HR=1.23,p<0.001)。最近几年的allo-HSCT与改善的GFRS相关(对于每3年的增量,HR=0.89,p<0.001),OS(HR=0.9,p=0.02),NRM降低(HR=0.82,p=0.008)。TBI改进了LFS。(HR=0.79,p=0.02),GRFS(HR=0.83,p=0.04),和复发率(RI)(HR=0.65,p<0.001)。女性到男性的移植对GRFS(HR=1.21,p=0.02)和OS(HR=1.23,p=0.048)产生负面影响。体内T细胞消耗显著改善GFRS(HR=0.74,p<0.001)。这项大型研究确定了预后因素,如移植调理方案的年龄,影响接受allo-HSCT的成人T-ALL患者的移植后。重要的是,随着时间的推移,显着改善。这些发现为新的适应性治疗策略带来了巨大的希望,并可以作为该背景下未来研究的基准。
T-cell acute lymphoblastic leukemia (T-ALL) predominantly affects individuals in late childhood and young adulthood. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative modality particularly in the setting of poor risk genetics and/or persistent minimal residual disease. Limited studies have directly explored the impact of patient- and transplant-related factors on post-transplant outcomes in T-ALL. Using a large dataset from the European Society for Blood and Marrow Transplantation registry, we identified 1907 adult T-ALL patients (70% male) who underwent their first allo-HSCT in first complete remission (CR1) from matched sibling donors (MSD; 45%), unrelated donors (UD; 43%) or haploidentical donors (12%) between 2010 and 2021. The median age at transplant was 33.4 years (18.1-75). The median follow up was 2.9 years. Most patients underwent total body irradiation (TBI)-based myeloablative conditioning (69%). The 2-year overall survival (OS) was 69.4%, and leukemia -free survival (LFS) was 62.1%. In multivariate analysis, advanced age at transplant negatively affected LFS (for each 10-year increment, HR = 1.11, p = 0.004), GVHD-free, relapse-free survival (GRFS) (HR = 1.06, p = 0.04), OS (HR = 1.12, p = 0.002), and non-relapse mortality (NRM) (HR = 1.23, p < 0.001). More recent years of allo-HSCT were associated with improved GFRS (For each 3-year increment, HR = 0.89, p < 0.001), OS (HR = 0.9, p = 0.02), and decreased NRM (HR = 0.82, p = 0.008). TBI improved LFS. (HR = 0.79, p = 0.02), GRFS (HR = 0.83, p = 0.04), and relapse incidence (RI) (HR = 0.65, p < 0.001). Female-to-male transplant negatively affected GRFS (HR = 1.21, p = 0.02) and OS (HR = 1.23, p = 0.048). In vivo T-cell depletion significantly improved GFRS (HR = 0.74, p < 0.001). This large
study identified prognostic factors, such as age at transplant conditioning regimen, in influencing post-transplant in adult T-ALL patients undergoing allo-HSCT. Importantly, a significant improvement over time was noted. These findings hold great promise for new adapted treatment strategies and can serve as a benchmark for future studies in that setting.