scholarly journals D-Dimer As a Predictor of Thrombotic Events during Early Acute Lymphoblastic Leukemia Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 5-6
Author(s):  
Daniela R. Anderson ◽  
Avi Leader ◽  
Theodore G. Karrison ◽  
Wendy Stock
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Acute Lymphoblastic Leukemia ◽  
Cumulative Incidence ◽  
Lymphoblastic Leukemia ◽  
Bleeding Events ◽  
Platelet Level ◽  
Thrombosis Risk ◽  
Chi Square Analysis ◽  
D Dimer

Background Patients with acute lymphoblastic leukemia (ALL) are at increased risk of thrombotic and or bleeding events during chemotherapy, especially when receiving L-Asparaginase (ASP). Previous studies have identified variables associated with increased thrombotic risk in ALL including age, body mass index (BMI), sex, platelet count, and ASP use (Orvain 2020); however, to date no ALL-based study has examined D-dimer, a marker of fibrinolysis that has been shown to predict thrombosis in acute myelogenous leukemia (AML) (Libourel 2016), in this context. We sought to examine the utility of D-dimer as a biomarker for risk of thrombosis or bleeding events during ALL treatment. Methods In this retrospective cohort study we identified 61 adult patients with newly diagnosed ALL from a single center between 2008 and 2020. Patient demographic details, treatment regimens, and biomarkers including D-dimer (ordered routinely at diagnosis as a serum assay in mcg/ml FEU) were ascertained. Patients were stratified according to D-dimer level using a cut-off of ≥4 mcg/ml (high) and <4 mcg/ml (low-moderate) based upon previous work examining D-dimer and thrombosis in AML (Libourel 2016). The disseminated intravascular coagulation (DIC) score according to the International Society on Thrombosis and Haemostasis (ISTH) was calculated at diagnosis. Major and clinically relevant non-major bleeding and first arterial or venous thrombotic event (confirmed by imaging) within 100 days of ALL diagnosis were recorded. The 100-day cumulative incidence of thrombosis was calculated for both D-dimer groups. Event rate was compared between D-dimer groups using chi-square analysis. Logistic regression was used to examine D-dimer as a continuous or categorical variable and compare events through 100 days. Six multivariate models, each including D-dimer and one of six previously identified thrombosis risk factors were performed. A receiver operating characteristic curve (ROC) was generated and area under the curve (AUC) calculated. Results Sixty-one patients with ALL were included; 52% were female and 48% male. Median age was 36 years (range 18-84). Patients were 18% Black, 26% Latinx, 52% White, and 3.3% Asian/Mideast Indian. Immunophenotypes included B-cell (82%), T-cell (8.2%), and mixed phenotype ALL (9.8%), with 24% of patients having Ph + or Ph-like status. ASP-based regimens were utilized in 67% of patients. The median D-dimer level was 2.1 mcg/ml (range: 0.26 to 20). The 100-day cumulative incidence of thrombosis was 53% (95% CI 26.4-73.8) in the high D-dimer group (N=17, 28%) and 14% (95% CI 5.5 - 25.5) in the low-moderate D-dimer group (N=44, 72%) (Figure 1). The rate of thrombosis was higher in the high D-dimer group, X2 (1, N=61) =10.2, p=.001. The odds of thrombosis within 100 days increased by 1.65 per every 3-unit increase in D-dimer (95% CI 1.2-2.27). The association between D-dimer and thrombosis remained after including additional confounders such as BMI, age, sex, ASP status, DIC score, and initial platelet level in covariate logistic regression models. ROC analysis demonstrated 60% sensitivity and 80% specificity for a D-dimer cutoff of 4 mcg/ml, with an AUC of 0.798 (95% CI 0.67-0.92). Clinically relevant bleeding occurred in 8 patients (13%) during the first 100 days after diagnosis and was not significantly associated with initial D-dimer level, BMI, age, sex, ASP status, DIC score, or initial platelet level. Conclusion High D-dimer (≥4 mcg/ml) at ALL diagnosis is associated with an increased rate of venous or arterial thrombosis within the first 100 days, with no increased rate of clinically relevant bleeding. D-dimer as a continuous variable appears to have good independent diagnostic discrimination for thrombosis. Prospective studies aiming to create ALL-specific thrombosis risk assessment models are warranted and should consider D-dimer level at diagnosis together with previously identified risk factors (Al-Ani 2020, Orvain 2020). Disclosures Leader: Bayer Healthcare: Other: personal fees ; Pfizer Pharmaceuticals Israel Ltd.: Consultancy, Honoraria, Other: personal fees .

A Retrospective Multicenter Study from the Nordic Society of Pediatric Hematology and Oncology (NOPHO) on Cerebral Sinus Venous Thromboses in Children with Acute Lymphoblastic Leukemia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 584-584
Author(s):  
Susanna Ranta ◽  
Nadine Gretenkort Andersson ◽  
Ulf R. Tedgard ◽  
Tony Frisk ◽  
Maria Winther Gunnes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Clinical Risk Factors ◽  
Bleeding Complications ◽  
Cerebral Veins ◽  
Thrombotic Risk ◽  
Clinical Risk ◽  
Cerebral Sinus ◽  
D Dimer

Abstract Introduction Cerebral sinus venous thrombosis (CSVT) is potentially life-threatening thrombosis with mortality around 10%. Venous thromboembolism (VTE) is a common complication in children with cancer. These children have several thrombotic risk factors such as the malignancy itself, severe infections, prothrombotic medication and immobilization. The treatment of acute lymphoblastic leukemia (ALL) includes steroids and asparaginase (ASP), raising the VTE risk. In children with ALL the central nervous system (CNS) is a common localization for VTE. However, retrospective studies on small numbers of patients, larger studies and population-based data in children are scarce. The five Nordic countries, Estonia and Lithuania have a common treatment protocol for children with ALL between 1 and 18 years of age with prospective registration of toxicities, including CSVT offering a unique opportunity to study CSVT in this patient group. This is to our knowledge the largest report of children with ALL and CSVT describing the incidence, symptoms, treatment and the effect of CSVT on ALL treatment. Methods We assessed the symptoms, treatment, clinical risk factors and outcome of all children between ages 1 and 17 years at diagnosis of B-cell precursor or T-cell ALL between June 2008 and July 2013 and with CSVT. Data were collected from the patients’ medical records and the NOPHO leukemia registry. Results In total, 20 (1.9%) of the 1038 children with ALL treated according to the NOPHO ALL 2008 protocol developed CSVT. The cumulative incidence of CSVT was 2.0%. All the thromboses occurred within the first 5 months of treatment. The most common symptoms at the diagnosis of CSVT were headache, convulsions, weakness/fatigue and cerebral nerve palsy/hemiparesis/hemiplegia. The most frequent localizations for CSVT were sinus sagittalis (n=16) and sinus transversus (n=10). However, in most cases multiple cerebral veins were involved ( 70%). Median D-dimer at time of the CSVT diagnosis was 0.85 mg/L (range 0.19-4.7 mg/L) with 5 patients having normal D-dimer. We could not identify any clinical risk factors for CSVTs. CSVT was associated with steroids (treatment within 2 weeks before the diagnosis of CSVT) in 16/20 and with Pegylated asparaginase in 16/20. Fifteen patients were later screened for the inherited thrombophilic factors; one child had heterozygous prothrombin G20110A mutation and another heterozygous factor V (R506Q) Leiden mutation. Most patients (19/20) were treated with anticoagulants: mostly low molecular weight heparin (LMWH). The median treatment with LMWH was 26 weeks (range 14-119 weeks). No bleeding complications were observed in connection with LMWH. Two deaths were directly related to CSVT. Asparaginase was omitted from the treatment in 7 and delayed or reduced in 5 of the cases raising the risk for subsequent suboptimal leukaemia treatment. Of the surviving 18 patients, follow-up imaging revealed complete recanalization in 7 and partial recanalization in 7 cases. No imaging was available for the remaining 4 patients. Conclusions The incidence of CSVT in children with ALL was approximately 2%. No statistically significant clinical predictors for CSVT were identified. The mortality related to CSVT was 10%. Anticoagulation with LMWH was the treatment of choice in most cased and was well tolerated. Disclosures No relevant conflicts of interest to declare.

Prospective Study on Incidence, Risk Factors, and Long-Term Outcome of Osteonecrosis in Pediatric Acute Lymphoblastic Leukemia

2011 ◽  
Vol 29 (31) ◽  
pp. 4143-4150 ◽  
Author(s):  
Mariël L. te Winkel ◽  
Rob Pieters ◽  
Wim C.J. Hop ◽  
Hester A. de Groot-Kruseman ◽  
Maarten H. Lequin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Cumulative Incidence ◽  
Multivariate Regression ◽  
Pediatric Patients ◽  
Lymphoblastic Leukemia ◽  
Long Term Outcome ◽  
Female Sex ◽  
Incidence Risk

Purpose We studied cumulative incidence, risk factors, therapeutic strategies, and outcome of symptomatic osteonecrosis in pediatric patients with acute lymphoblastic leukemia (ALL). Patients and Methods Cumulative incidence of osteonecrosis was assessed prospectively in 694 patients treated with the dexamethasone-based Dutch Child Oncology Group–ALL9 protocol. Osteonecrosis was defined by development of symptoms (National Cancer Institute grade 2 to 4) during treatment or within 1 year after treatment discontinuation, confirmed by magnetic resonance imaging. We evaluated risk factors for osteonecrosis using logistic multivariate regression. To describe outcome, we reviewed clinical and radiologic information after antileukemic treatment 1 year or more after osteonecrosis diagnosis. Results Cumulative incidence of osteonecrosis at 3 years was 6.1%. After adjustment for treatment center, logistic multivariate regression identified age (odds ratio [OR], 1.47; P < .01) and female sex (OR, 2.23; P = .04) as independent risk factors. Median age at diagnosis of ALL in patients with osteonecrosis was 13.5 years, compared with 4.7 years in those without. In 21 (55%) of 38 patients with osteonecrosis, chemotherapy was adjusted. Seven patients (18%) underwent surgery: five joint-preserving procedures and two total-hip arthroplasties. Clinical follow-up of 35 patients was evaluated; median follow-up was 4.9 years. In 14 patients (40%), symptoms completely resolved; 14 (40%) had symptoms interfering with function but not with activities of daily living (ADLs; grade 2); seven (20%) had symptoms interfering with ADLs (grade 3). In 24 patients, radiologic follow-up was available; in six (25%), lesions improved/disappeared; in 13 (54%), lesions remained stable; five (21%) had progressive lesions. Conclusion Six percent of pediatric patients with ALL developed symptomatic osteonecrosis during or shortly after treatment. Older age and female sex were risk factors. After a median follow-up of 5 years, 60% of patients had persistent symptoms.

The Development Of Venous Thromboembolism May Increase The Risk Of Osteonecrosis In Children With Acute Lymphoblastic Leukemia

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3864-3864
Author(s):  
Badhiwala H. Jetan ◽  
Trishana Nayiager ◽  
Uma H. Athale
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Venous Thromboembolism ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Older Age ◽  
Regression Analyses ◽  
Female Ratio ◽  
Increased Risk ◽  
The Impact

Abstract Background Osteonecrosis (ON) is a severely disabling complication of anti-leukemic therapy, specifically long-term corticosteroid use. A hypercoagulable state is thought to underlie corticosteroid-related ON. Children with acute lymphoblastic leukemia (ALL) are also at increased risk of venous thromboembolism (VTE), indicating underlying hypercoagulability in this disease entity. Hence, we explored the relationship between ON and VTE, along with the association of ON with other variables, including age and asparaginase (ASP) therapy, in children with ALL. Methods Health records of children (< 18 yrs.) with de novo ALL treated at McMaster Children’s Hospital from 1992 to 2010 were reviewed. Patients were treated according to Dana-Farber Cancer Institute (DFCI) ALL Consortium Protocols. Data regarding demographics, leukemia diagnosis and therapy, development and characteristics of ON and VTE, and thrombophilia work-up, if any, were collected from computer records and chart review. Osteonecrosis was diagnosed by plain X-ray, computed tomography (CT), magnetic resonance (MR) imaging, and/or technetium-99m (99mTc) bone scan. We included ON diagnosed during therapy and/or at any point during post-treatment follow-up. Standard radiological measures, including venous Doppler ultrasound and/or venography (conventional, CT, MR), confirmed VTE. We included only clinically significant thromboembolic events, defined as symptomatic VTE, or asymptomatic VTE requiring anticoagulation, developing during ALL therapy. Logistic regression analyses were performed to identify possible predictors of ON. Odds ratios (ORs) with 95% confidence intervals (CIs) and corresponding p-values were determined. Results Mean age of the study cohort (n = 208) was 5.4 years and male/female ratio 1.2:1. Seventy-eight (37.5%) patients had high-risk (HR) ALL and 127 (61.1%) received dexamethasone (DEX) as post-induction steroid. One hundred and sixty-two (77.9%) patients received E. coli ASP, 19 (9.1%) Erwinia ASP, and 27 (13.0%) PEG ASP. Twenty-one (10.1%) children developed ON. Joints affected by ON included the ankle in 11 subjects, knee in 10, hip in 8, and heel in one. Fourteen of the 21 patients (66.7%) had involvement of more than one joint. All patients were diagnosed with ON during ALL treatment, with the average being 69.2 weeks following ALL diagnosis. Forty-two (20.2%) subjects had a VTE while receiving therapy at an average of 29.4 weeks after ALL diagnosis. Nine patients had cerebral sinovenous thrombosis, 7 deep vein thrombosis (DVT), and one pulmonary embolism (PE). Twenty-six patients developed a central venous line (CVL)-related VTE. Results of univariate logistic regression analyses for osteonecrosis are presented in Table 1. VTE strongly predicted development of ON – OR 8.85 (95% CI 3.37–23.25, p< 0.001). Thirteen (31.0%) patients with VTE developed ON compared to 8 (4.8%) of 166 subjects without VTE. In 10 of 13 (76.9%) patients who developed both VTE and ON, the diagnosis of VTE preceded that of ON. Given that older age is a known risk factor for both VTE and ON, we conducted a multivariate analysis, which confirmed that age, ASP type, and VTE were independent, significant risk factors for ON (Table 2). Conclusion In addition to the known impact of older age, we identified VTE and type of ASP as independent risk factors for ON in children with ALL. These observations suggest overlap in the etiopathogenesis of ON and VTE. We recommend larger, prospective studies to confirm the association of VTE and PEG ASP with ON and to assess the impact of hypercoagulability on the development of ON. This in turn may help develop preventive strategies (e.g., thromboprophylaxis) for ALL-associated ON. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Sex-Based Disparities in Outcome in Childhood Acute Lymphoblastic Leukemia (ALL): A Children's Oncology Group (COG) Report

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 38-39
Author(s):  
Sumit Gupta ◽  
David T. Teachey ◽  
Meenakshi Devidas ◽  
Zhiguo Chen ◽  
Kimberly P. Dunsmore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Acute Lymphoblastic Leukemia ◽  
Treatment Failure ◽  
Cumulative Incidence ◽  
Research Funding ◽  
Lymphoblastic Leukemia ◽  
Publicly Traded ◽  
Cns Relapse ◽  
Standard Risk

BACKGROUND: Survival for children with B and T acute lymphoblastic leukemia (B-ALL, T-ALL) has continued to improve. In past cohorts, boys experienced inferior survival outcomes compared to girls. Though reasons are unknown, previous investigators have suggested that these disparities are explained by imbalances in risk factors, such as a higher proportion of T-ALL among boys. We thus examined whether sex-based disparities persist with modern intensive therapy when adjusted for other risk factors. We also determined if patterns of toxicity and treatment failure varied by sex. METHODS: We identified a cohort of patients age 1-30.99 years enrolled on frontline COG trials for B-ALL (standard risk: AALL0331; high risk: AALL0232) and T-ALL (AALL0434) between 2004-2014. Duration of treatment was sex-dependent, with boys receiving an additional year of Maintenance therapy. A limited number of B-ALL patients (those with slow early response or CNS3 status) underwent cranial radiation, while all intermediate and standard risk T-ALL patients did so. Sex-based differences in the distribution of various prognostic factors were explored, including age at diagnosis, initial white blood cell (WBC) count, central nervous system (CNS) status, leukemia cytogenetics, and end Induction minimal residual disease (MRD). Event-free and overall survival (EFS, OS) were compared between boys and girls using log-rank tests and multivariable Cox regression analyses. Finally, we explored sex-based differences in toxicity rates and in the cumulative incidence of specific causes of treatment failure, including treatment-related mortality (TRM), overall relapse, and subcategories of relapse by site. RESULTS: The study cohort included 8,202 patients with B-ALL [4,463 (54.4%) boys] and 1,562 patients with T-ALL [1,161 (74.3%) boys]. Among B-ALL patients, boys were older than girls and slightly more likely to have unfavorable cytogenetics (Table 1). There was no difference in the distribution of initial WBC or CNS status. Among T-ALL patients, boys were again older than girls, but other prognostic factors did not differ by sex (Table 1). B-ALL boys were less likely to be end induction marrow MRD &lt; 0.01% [3,268 (76.1%) vs. 2791 (78.1%); p=0.04] while T-ALL boys were more likely to achieve end induction MRD &lt; 0.01% [659 (59.0%) vs. 221 (56.8%); p=0.01], although in both cases absolute differences were small. EFS and OS were inferior in B-ALL boys compared to girls (5-year: EFS 84.6%±0.6% vs. 86.4%±0.6%; p=0.003; OS 91.7%±0.4% vs. 92.8%±0.5%; p=0.046). The risk of inferior outcomes among B-ALL boys persisted after adjustment for other prognostic factors in both EFS [hazard ratio (HR) 1.18, 95% confidence interval (1.05-1.33); p=0.003] and OS (HR 1.17 (1.00-1.37); p=0.048). There were no sex-based differences in EFS or OS in T-ALL. When examining specific toxicities and causes of treatment failure, osteonecrosis rates were lower among boys [297/5,624 (5.3%) vs. 281/4,140 (6.8%); p=0.002]. The incidence of TRM did not differ by sex. The incidence of relapse was, however, greater in boys than girls with B-ALL (11.2%±0.5% vs. 9.6%±0.5%; p=0.001). This risk was attributable to a higher incidence of relapses involving the CNS (4.2%±0.3% vs. 2.5%±0.3%; p&lt;0.0001) and in other extramedullary sites, including the testes (1.3%±0.2% vs. 0.7%±0.1%; p= 0.001). Notably, there was no difference in the cumulative incidence of isolated bone marrow relapse (5.4%±0.4% vs. 6.2%±0.4%; p=0.49). Among T-ALL patients, there were no sex-based differences in the cumulative incidence of relapse, either overall or by relapse site. CONCLUSIONS: Small sex-based disparities in ALL outcomes persist despite overall improvements, extended treatment duration, and extra intrathecal therapy in boys. This is mainly attributable to a higher risk of CNS relapse in boys with B-ALL, despite no sex-based differences in initial CNS status, and persists when adjusted for other prognostic risk factors. The lack of sex-based disparities in T-ALL by sex may be in part due to an increased use of CNS radiation, given older studies which observed increases in CNS relapse rates among boys but not girls when radiation was eliminated. Future studies to determine the mechanisms underlying this disparity, including potential sex-based differences in steroid metabolism, are warranted. Disclosures Teachey: Amgen: Consultancy; Sobi: Consultancy; Janssen: Consultancy; La Roche: Consultancy. Dunsmore:Dexcom: Current equity holder in publicly-traded company. Mattano:Melinta Therapeutics: Consultancy; Novartis: Consultancy; Pfizer: Consultancy. Borowitz:Amgen: Honoraria. Raetz:Pfizer: Research Funding; Celgene/BMS: Other. Loh:Pfizer: Other: Institutional Research Funding; Medisix Therapeutics: Membership on an entity's Board of Directors or advisory committees. Hunger:Novartis: Consultancy; Amgen Inc.: Current equity holder in publicly-traded company, Honoraria.

Incidence, characteristics, and risk factors of venous thromboembolism in adolescent and young adult acute lymphoblastic leukemia patients receiving peg-asparaginase.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18520-e18520
Author(s):  
Brynne Underwood ◽  
Qiuhong Zhao ◽  
Alison R. Walker ◽  
Alice S. Mims ◽  
Sumithira Vasu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Acute Lymphoblastic Leukemia ◽  
Cumulative Incidence ◽  
Regression Models ◽  
Lymphoblastic Leukemia ◽  
Adolescent And Young Adult ◽  
Hazard Ratios ◽  
Adolescent And Young Adults ◽  
Male Sex

e18520 Background: Venous thromboembolism (VTE) is common in acute lymphoblastic leukemia (ALL) patients (pts) receiving peg-asparaginase (ASNase) however there is limited data regarding the incidence of VTE and risk factors for VTE in adolescent and young adults (AYA) treated with ASNase. Methods: This is a single institutional retrospective analysis of AYA pts with ALL who received ASNase from January 2013 to December 2018. Time to VTE was calculated from date of starting treatment to onset of VTE or censored at last assessment date, treating death as a competing risk. The cumulative incidence of VTE was estimated and the Fine and Gray regression models accounting for competing risks were used to examine the association between risk factors and VTE. Results: Forty-six AYA ALL patients were included. Pt characteristics are shown in the Table. Twenty pts had a VTE following ASNase with the cumulative incidence rate of 35% (95% CI: 22-48%) at 100 days. The most common VTE sites were cerebral (n=6) and upper extremity (n=6). Nine pts (43%) had at least one recurrent VTE. After initial VTE, ASNase was continued in 13 pts (62%), stopped in 6 pts (29%), and dose reduced in 2 pts (10%). Nine pts (45%) of those who developed VTE received antithrombin. Out of the 6 pts with VTE who had ASNase discontinued or dose reduced, 2 (33%) had progression of ALL. The hazard ratios (HR) for risk of VTE from univariable regression models are listed in Table 1. Male sex was associated with increased VTE risk, with HR=3.33 (95% CI: 1.13-9.77). Conclusions: Our study estimated the incidence of VTE in the AYA cohort. Only male sex was identified as a risk factor for VTE. Additional studies are needed to assess VTE risk factors in AYA pts with ALL. Pt characteristics and hazard ratios for risk of VTE. [Table: see text]

scholarly journals Post-transplant cyclophosphamide containing regimens after matched sibling, matched unrelated and haploidentical donor transplants in patients with acute lymphoblastic leukemia in first complete remission, a comparative study of the ALWP of the EBMT

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jaime Sanz ◽  
Jacques-Emmanuel Galimard ◽  
Myriam Labopin ◽  
Boris Afanasyev ◽  
Moiseev Ivan Sergeevich ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Cumulative Incidence ◽  
Lymphoblastic Leukemia ◽  
Hematopoietic Stem ◽  
Free Survival ◽  
Post Transplant ◽  
Gvhd Prophylaxis ◽  
Donor Type ◽  
Matched Sibling ◽  
The Impact

Abstract Background There is no information on the impact of donor type in allogeneic hematopoietic stem cell transplantation (HCT) using homogeneous graft-versus-host (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) in acute lymphoblastic leukemia (ALL). Methods We retrospectively analyzed outcomes of adult patients with ALL in CR1 that had received HCT with PTCy as GVHD prophylaxis from HLA-matched sibling (MSD) (n = 78), matched unrelated (MUD) (n = 94) and haploidentical family (Haplo) (n = 297) donors registered in the EBMT database between 2010 and 2018. The median follow-up period of the entire cohort was 2.2 years. Results Median age of patients was 38 years (range 18–76). Compared to MSD and MUD, Haplo patients received peripheral blood less frequently. For Haplo, MUD, and MSD, the cumulative incidence of 100-day acute GVHD grade II–IV and III–IV, and 2-year chronic and extensive chronic GVHD were 32%, 41%, and 34% (p = 0.4); 13%, 15%, and 15% (p = 0.8); 35%, 50%, and 42% (p = 0.01); and 11%, 17%, and 21% (p = 0.2), respectively. At 2 years, the cumulative incidence of relapse and non-relapse mortality was 20%, 20%, and 28% (p = 0.8); and 21%, 18%, and 21% (p = 0.8) for Haplo, MUD, and MSD, respectively. The leukemia-free survival, overall survival and GVHD-free, relapse-free survival for Haplo, MUD, and MSD was 59%, 62%, and 51% (p = 0.8); 66%, 69%, and 62% (p = 0.8); and 46%, 44%, and 35% (p = 0.9), respectively. On multivariable analysis, transplant outcomes did not differ significantly between donor types. TBI-based conditioning was associated with better LFS. Conclusions Donor type did not significantly affect transplant outcome in patient with ALL receiving SCT with PTCy.

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