Allogeneic Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults With Acute Lymphoblastic Leukemia—A Retrospective, Dual‐Center Study
Bibliographic record
Abstract
Survival outcomes for adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) have improved with modern frontline therapies and minimal residual disease (MRD)-guided strategies. As a result, allogeneic hematopoietic cell transplantation (HCT) is increasingly deferred in first remission (CR1) and used in the relapsed setting. However, data on HCT outcomes in second remission (CR2) remain limited in AYAs. We conducted a dual-center retrospective study of AYA patients aged 15-40 years who underwent HCT in CR2 between 2010 and 2022. Among 164 patients, the median age was 25 years; 66% were male and 80% had B-ALL. Frontline therapies included pediatric-inspired (54%) and hyperCVAD-based (33%) regimens. Most received myeloablative conditioning (74%), and 67% were MRD-negative at HCT. At a median follow-up of 36 months, 3-year overall survival (OS) and progression-free survival (PFS) were 53% and 46%. The 3-year cumulative incidences of relapse and non-relapse mortality were 36% and 18%, respectively. The 6-month incidence of grade 2-4 acute graft-versus-host disease (GVHD) was 36%, and grade 3-4 was 14%. Chronic GVHD occurred in 27% at 3 years, with 37% moderate and 25% severe. On multivariable analysis, a HCT-specific comorbidity index > 3 was independently associated with inferior OS, PFS, and higher non-relapse mortality. MRD positivity predicted worse PFS and higher relapse risk but not OS. These findings support HCT in CR2 as a curative option for AYA patients with ALL. Outcomes are influenced by MRD status and comorbidities, underscoring the need for risk-adapted transplant strategies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".