P362: OUTCOMES IN PATIENTS WITH RELAPSED OR REFRACTORY ACUTE LYMPHOBLASTIC LEUKEMIA RECEIVING HEMATOPOIETIC CELL TRANSPLANTATION USING REAL-WORLD DATA FROM HARMONY
Notice bibliographique
Résumé
Background: Hematopoietic cell transplantation (HSCT) is a standard consolidation treatment for patients (pts) with relapsed or refractory (R/R) acute lymphoblastic leukemia (ALL). However, predicting post-HSCT survival and related outcomes remains a challenge because of limited samples, outdated published evidence, and studies focussed on de novo ALL. HARMONY Alliance is a large multi-national public-private partnership aiming to gather data on hematologic cancers currently maintained in several individual databases from clinical trials and registries across Europe. The HARMONY data platform contains anonymized data of ~10,000 pts with ALL. Aims: To estimate post-HSCT outcomes, including overall survival (OS), and to identify clinical factors correlated with post-HSCT outcomes using real-world data from HARMONY. Methods: A dataframe was constructed within HARMONY to include pts with R/R ALL who had received HSCT. OS was assessed post-HSCT using Kaplan-Meier time-to-event analyses. Results: A total of 235 adult pts diagnosed with R/R ALL between 1995 and 2019 who received ≥1 allogeneic or unspecified HSCT were included in the analysis. Most pts were male (63.8 %; n=150), Philadelphia-chromosome negative (64.7%; n=152), and had B-cell ALL (71.1 %; n=167); median age at ALL diagnosis was 25.0 years (range, 7.7‒71.0) and at HSCT was 26.8 years (range, 18.5‒71.6). Within 3 years of HSCT, acute graft-versus-host disease (GvHD) was recorded and graded in 11.1 % (n=26) of pts and chronic GvHD was recorded in 4.3% (n=10) of pts. At a median follow-up of 65.7 months (range, 0.3‒169.4), median OS (95% CI) from HSCT was 9.4 months (7.5‒13.8; Fig 1A), with a 1-year OS rate of 45.3 %, and a plateau starting from year 4. Subgroup analyses indicate variation in OS by minimal residual disease (MRD) status before HSCT, age group at HSCT, and time period of HSCT. In the limited number of records where MRD-status before HSCT was available, OS appeared longer in pts with MRD-negativity (n=17) vs MRD-positivity (n=25) at the most recent MRD assessment before HSCT (1-year OS=70.1% vs 50.1%; p=0.324, not significant]; Fig 1B). OS after 1 year was higher in pts <55 years (n=215, 47.3%) vs ≥55 years (n=20, 24.0%) p=0.025; Fig 1C). One-year OS was significantly higher in pts originally diagnosed with ALL in childhood (<18 years) with relapse and consolidating HSCT as adults (n=40, 66.5%) vs pts diagnosed as adults (≥18 years; n=195, 41.0%; p=0.005). Finally, OS following HSCT improved significantly over the historical HSCT periods of 1995‒1999 (n=36), 2000‒2009 (n=101), and 2010‒2019 (n=98); 1-year OS=25.0%, 45.5%, and 52.6%, respectively; p=0.002; Fig 1D). Median relapse-free survival (RFS; 95% CI) from HSCT was 7.6 months (6.1‒9.4), with a 1-year RFS rate of 38.8 %. Summary/Conclusion: This is one of the largest real-world studies focused on adult pts with R/R ALL. While the 1-year OS rate increased to 50% in recent time-periods, post-HSCT outcomes remain unsatisfactory. Recent transplant practices have improved survival. Factors such as younger age at diagnosis and transplant, and quality of pre-HSCT response (eg, reaching MRD-negativity) appear to positively influence post-HSCT survival.Keywords: ALL, Acute lymphoblastic leukemia, relapsed/refractory, Allogeneic stem cell transplant
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».