Autologous hematopoietic stem cell transplantation as late high-dose consolidation in adult patients with T-cell lymphoblastic leukemias: Results of a Russian multicenter study

作者：Parovichnikova E N^*; Kuzmina L A; Mendeleeva L P; Klyasova G A; Troitskaya V V; Sokolov A N; Akhmerzaeva Z Kh; Kravchenko S K; Gribanova E O; Zvonkov E E; Bondarenko S N; Baranova O Yu; Ryltsova T V; Gavrilova L V; Zinina E E; Pristupa A S; Kaporskaya T S; Minaeva N V; Samoilova O S; Konstantinova T S; Lapin V A; Kaplanov K D; Kryuchkova I V; Nizamutdinova A S; Klimovich A V; Borisenkova E A; Moskov V I

来源：Terapevticheskii Arkhiv, 2015, 87(7): 15-25.

DOI：10.17116/terarkh201587715-25

• T-cell acute lymphoblastic leukemias
• autologous hematopoietic stem cell transplantation

Aim. To analyze the efficiency of the ALL-2009 protocol (ClinicalTrials.gov NCT01193933) in patients with T-cell leukemias, particularly the role of autologous hematopoietic stem cell transplantation (auto-HSCT) after non-myeloablative BEAM conditioning, followed by maintenance therapy.
Subjects and methods. Since 2009, the ALL-2009 study has enrolled,90 patients with T-cell acute lymphoblastic leukemia (T-ALL), the treatment results were assessed in 86 patients: 6 and 28 patients underwent allogeneic HSCT and auto-HSCT, respectively. A landmark analysis was used to compare survival rates in patients who had undergone auto-HSCT and in those who had not. For this, the median time from complete remission to the date of auto-HSCT was determined (the median was 6 months). Then to compare with the auto-HSCT group, only 27 patients who had been in complete remission for 6 months or more were included in a chemotherapy group.
Results. The achievement of complete remission in patients with thymic T-ALL (100%) was significantly higher than in those with early (85.7%) or mature (70%) variants. The patients with early and mature T-ALL as compared to those with thymic T-ALL showed high death rates in the remission induction (7.4 and 10% versus 0) and the patients with mature T-ALL had a higher proportion of refractory forms (20% versus 0). The 5-year overall and relapse-free survival rates in all the T-ALL patients were 66 and 76%, respectively. After auto-HSCT, the risk of recurrence was 0% versus 21% after chemotherapy (p=0.03). The relapse-free survival rates significantly differed in the auto-HSCT and non-auto-HSCT groups: 100 and 66%, respectively (p=0.047).
Conclusion. The long-term survival rates obtained during this multicenter study in the T-ALL patients treated according to the ALL-2009 protocol, the basis for which is the principle of continuity of cytostatic effects, are exclusively optimistic. Late consolidation with auto-HSCT following non-myeloablative BEAM conditioning, followed by maintenance therapy, considerably reduces the risk of recurrence.

• 出版日期2015