Abstract
Hematopoietic stem cell transplantation (HSCT) is considered an effective way to prevent relapse in adults with acute lymphoblastic leukemia (ALL). This study aimed to assess general trends in the use of various types of HSCTs performed between 2001 and 2015 in Europe, based on data reported to the European Society for Blood and Marrow Transplantation registry. We also evaluated HSCT rates with respect to ALL incidence in selected countries. Altogether, 15,346 first allogeneic (n = 13,460) or autologous (n = 1886) HSCTs were performed in the study period. Comparing 2013–2015 and 2001–2003, the number of allogeneic HSCTs performed in first complete remission increased by 136%, most prominently for transplantations from unrelated (272%) and mismatched related donors (339%). The number of HSCTs from matched sibling donors increased by 42%, while the total number of autologous HSCTs decreased by 70%. Increased use of allogeneic HSCT was stronger for Philadelphia chromosome (Ph)-positive (166%) than for Ph-negative ALL (38%) and for patients aged > 55 years (599%) than for younger adults (59%). The proportion of allogeneic HSCT with reduced-intensity conditioning (RIC) increased from 6 to 27%. The age-standardized rates of allogeneic HSCT per ALL incidence varied strongly among countries. Our analysis showed a continued trend toward increased allogeneic HSCT use for adults with ALL, which may be attributed to increasing availability of unrelated donors, wider use of RIC regimens, and improving efficacy of pretransplant therapy, including tyrosine kinase inhibitors for Ph-positive ALL. Allogeneic HSCT remains a major tool in the fight against ALL in adults.
Highlights
MethodsAcute lymphoblastic leukemia (ALL) is one of the most aggressive malignancies
Among allogeneic hematopoietic stem cell transplantation (HSCT), unrelated donor (URD) were used in 6953 cases (52%), followed by matched sibling donor (MSD) (n = 5740; 43%) and mismatched related donors (MMRDs) (n = 767; 6%)
Comparing 2013–2015 and 2001–2003, the number of allogeneic HSCTs performed in first complete remission (CR) increased by 136%, most prominently for transplantations from URDs (272%) and MMRDs (339%)
Summary
MethodsAcute lymphoblastic leukemia (ALL) is one of the most aggressive malignancies. It is usually sensitive to multi-agent chemotherapy, which allows the initial achievement of complete remission (CR) in the majority of cases [1]. Approximately half of the patients achieving initial CR will relapse, which is associated with a very poor prognosis [2]. Allogeneic hematopoietic stem cell transplantation (HSCT) is considered an effective way to prevent relapse. It offers a chance to use myeloablative doses of chemotherapy and/or radiotherapy and may be associated with the beneficial graftversus-leukemia reaction mediated by T cells of donor origin. The efficacy of allogeneic HSCT was confirmed in prospective trials conducted in the 1990s, comparing long-term outcome in subgroups defined based on the availability of human leukocyte antigen (HLA)-matched sibling donor (MSD) [3, 4]. Novel immunosuppressive protocols have been elaborated, allowing for transplantations from partially mismatched related donors (MMRDs), namely haploidentical donors [6]
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