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Hematopoietic stem cell transplantation for acute lymphoblastic leukemia: why do adolescents and young adults outcomes differ from those of children? A retrospective study on behalf of the Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC)

  • Original Article – Clinical Oncology
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Abstract

Purpose

In the acute lymphoblastic leukemia (ALL) landscape, adolescents and young adults (AYA) often present high-risk diseases and increased chemotherapy-related toxicity. Studies analyzing the outcomes of AYA after hematopoietic stem cell transplantation (HSCT) are scarce. Our study aimed to compare the outcomes of children and AYA with ALL after HSCT and to determine the factors influencing potential differences.

Method

891 patients, from the SFGM-TC registry, aged between 1 and 25 years who received HSCT between 2005 and 2012 were included. The outcomes of AYA were compared to the ones of their younger counterparts.

Results

Five-year OS and GRFS were lower in AYA: 53.1% versus 64% and 36% versus 47% (p = 0.0012 and p = 0.007, respectively). WhileCIR was similar in both groups, 5 year-treatment related mortality was higher in AYA: 19% versus 13% (p = 0.04). The lower GRFS in AYA was mainly explained by a higher chronic graft versus host disease (cGvHD) incidence: 32% versus 19% (p < 0.001). Use of peripheral blood stem cells and use of anti-thymoglobulin appeared to be the main factors impacting cGvHD occurrence in AYA.

Conclusion

AYA have worse outcomes than children after HSCT for ALL because of a greater risk of TRM due to cGvHD. HSCT practices should be questioned in this population.

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Acknowledgements

The authors are particularly thankful to the SFGM-TC who provided data and to all centers from the SFGM-TC who included patients and kindly agreed to participate in this study.

Funding

No funding was secured for this manuscript.

Author information

Authors and Affiliations

  1. Pediatric Hematology-Oncology Department, CHU Hopital Mère-Enfant, Nantes, France

    Audrey Grain & Fanny Rialland-Battisti

  2. Hematology Department, CHU Hotel Dieu, Nantes, France

    Patrice Chevallier & Nicolas Blin

  3. Robert Debré University Hospital (APHP), Université de Paris, Paris, France

    Jean-Hugues Dalle & André Baruchel

  4. Department of Paediatric Haematology and Oncology and EA3279, Timone Children Hospital and Aix-Marseille University, Marseille, France

    Gérard Michel

  5. AYA Unit, Clinical Hematology Departments, Saint-Louis Hospital, Paris, France

    Nathalie Dhédin

  6. BMT Unit, Department of Hematology, Hospital St. Louis, Paris, France

    Regis Peffault de Latour

  7. Allogeneic Hematopoietic Stem Cell Transplantation Unit, Department of Pediatric Oncohematology, Nancy University Hospital, Vandœuvre-lès-Nancy, France

    Cécile Pochon

  8. CHU de Lille, Université de Lille, LIRIC, Inserm U995, Lille, France

    Ibrahim Yakoub-Agha

  9. Institut of Hematology and Pediatric Oncology, Hospices Civils de Lyon, Université Lyon 1, Lyon, France

    Yves Bertrand

  10. Department of Clinical Haematology, CHU Montpellier, Montpellier, France

    Anne Sirvent

  11. Department of Pediatric Hematology, Bordeaux Hospital, Bordeaux, France

    Charlotte Jubert

  12. Department of Hematology and Cellular Therapy, CHU Bordeaux, Bordeaux, France

    Edouard Forcade

  13. Department of Hematology, CHU Besançon, Besançon, France

    Ana Berceanu

  14. Department of Pediatric Oncology and Haematology, University Hospital of Rennes, Rennes, France

    Virginie Gandemer

  15. Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Rouen, Rouen, France

    Pascale Schneider

  16. Department of Hematology and Cellular Therapy CHU Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France

    Jacques-Olivier Bay

  17. Pediatric Hematology Department, CHU de Nice, Nice, France

    Pierre-Simon Rohrlich

  18. Department of Haematology, Hôpital Saint-Antoine, Paris, France

    Eolia Brissot

  19. Pediatric Oncohematology and Bone Marrow Transplantation Unit, Hôpital de Hautepierre, CHRU, Strasbourg, France

    Catherine Paillard

  20. Department of Pediatric Hematology-Oncology, University Hospital Grenoble, Grenoble, France

    Dominique Plantaz

  21. Department of Hematology, La Pitié University Hospital, Paris, France

    Stéphanie Nguyen Quoc

  22. Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277, CANTHER, Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000, Lille, France

    Fanny Gonzales

  23. Hematology Department, CHU Poitiers, Poitier, France

    Natacha Maillard

  24. Clinical Research Unit, CHD Vendée, La Roche sur Yon, France

    Lucie Planche

Authors
  1. Audrey Grain
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  2. Fanny Rialland-Battisti
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  3. Patrice Chevallier
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  9. Cécile Pochon
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  12. Anne Sirvent
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  13. Charlotte Jubert
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  15. Ana Berceanu
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  16. Virginie Gandemer
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  17. Pascale Schneider
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  20. Eolia Brissot
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  21. Catherine Paillard
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  22. Dominique Plantaz
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  23. Stéphanie Nguyen Quoc
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  24. Fanny Gonzales
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  25. Natacha Maillard
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  26. Lucie Planche
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  27. André Baruchel
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Contributions

AG and FR conceived and designed the study. AG, FR and AB wrote the manuscript. AG collected and assembled data. LP performed all the statistical analysis. All other co-authors included patients and critically reviewed the manuscript. All co-author consented to publish this manuscript.

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Correspondence to Audrey Grain.

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Grain, A., Rialland-Battisti, F., Chevallier, P. et al. Hematopoietic stem cell transplantation for acute lymphoblastic leukemia: why do adolescents and young adults outcomes differ from those of children? A retrospective study on behalf of the Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC). J Cancer Res Clin Oncol 149, 1473–1483 (2023). https://doi.org/10.1007/s00432-022-04021-1

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