Biol Blood Marrow Transplant. 2019 Apr 16. pii: S1083-8791(19)30237-X. doi: 10.1016/j.bbmt.2019.04.014. [Epub ahead of print]

Allogeneic stem cell transplantation for acute lymphoblastic leukemia in adolescents and young adults.

Hangai M¹, Urayama KY², Tanaka J³, Kato K⁴, Nishiwaki S⁵, Koh K⁶, Noguchi M⁷, Kato K⁸, Yoshida N⁹, Sato M¹⁰, Goto H¹¹, Yuza Y¹², Hashii Y¹³, Atsuta Y¹⁴, Mizuta S¹⁵, Kato M¹⁶.

Abstract

Hematologic stem cell transplantation (HSCT) is the most potent consolidation therapy for high-risk acute lymphoblastic leukemia (ALL), but their outcomes and complications in adolescent and young adult (AYA) patients are still unclear. We compared outcomes after HSCT for ALL among children (1 to 9 years old, n = 607), adolescents (10 to 19 years old, n= 783) and young adults (20 to 29 years old, n = 603), based on nationwide registry data in Japan. The overall survival rate among AYA patients was worse than that of children; survival rate at 5 years among AYA patients was 64% (95% confidence intervals [CI], 60% to 68%). The 5-year treatment-related mortality (TRM) of adolescents after HSCT was 19% (95% CI, 16% to 22%) which was significantly higher than younger patients. The most common cause of TRM among adolescents was infection. The relapse rate was not different across the three age groups. When focusing on older adolescents (15 to 19 years old), there was no difference in outcomes between pediatric and adult centers. In conclusion, adolescents had higher risk of non-relapse death than younger patients and infection was the most common cause. Further optimization is required for HSCT in AYA-ALL.