Retrospective Analysis of the Impact of Treatment on Prognosis in 44 Adolescents and Young Adult Patients with Acute Lymphoblastic Leukemia

Abstract

To study the clinical characteristics and the impact of treatment on prognosis in 44 adolescents and young adult (AYA) patients with acute lymphoblastic leukemia. Clinical data of 44 AYA ALL patients admitted in our hospital from September 1997 to April 2014 were analyzed retrospectively and the impact of treatment on overall survival (OS) and event free survival (EFS) were investigated. The median age of the patients at diagnosis was 23.7 (15-37) years and the male/female was 2.38:1. Out of them 88.6% of patients achieved complete remission (CR) after 1 course of induction chemotherapy, 35 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) and 6 patients received chemotherapy, 3 patients received autologous hematopoietic stem cell transplantation (auto-HSCT) as consolidation therapy in CR1. The expected 3-year OS and EFS rates of all the 44 patients were 64.3% and 61.7% respectively. The expected 5-year OS and EFS rates were 55.4% and 56.6% respectively. Allo-HSCT was not superior to chemotherapy and auto-HSCT in all the 44 patients (P = 0.308 for OS and P = 0.291 for EFS). In allo-HSCT group, the treatment related mortality was 22.9%, and the differences of OS and EFS in standard risk and poor risk AYA ALL patients were no significant (P = 0.775 for OS and P = 0.817 for EFS). However, compared with chemotherapy and auto-HSCT, allo-HSCT could significantly improve the OS and EFS in standard risk AYA ALL (P = 0.0296 for OS and P = 0.0359 for EFS). Allo-HSCT as consolidation therapy may provide survival improvement for standard risk AYA ALL. However, further prospectively randomized clinical study is warranted to confirm whether allo-HSCT is an optimal treatment for AYA ALL, which is still controversial at present.