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Efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation treatment for adolescent and adult Tlymphoblastic leukemia /lymphoma: a large cohort multicenter study in China

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Abstract

T lymphoblastic leukemia /lymphoma (T-ALL/LBL) is a rare and highly aggressive neoplasm of lymphoblasts. We evaluated 195 T-ALL/LBL adolescent and adult patients who received ALL-type chemotherapy alone (chemo,n = 72) or in combination with autologous hematopoietic stem cell transplantation(auto-HSCT,n = 23) or allogeneic hematopoietic stem cell transplantation(allo-HSCT,n = 100) from January 2006 to September 2020 in three Chinese medical centers. 167 (85.6%) patients achieved overall response (ORR) with 138 complete response (CR) patients (70.8%) and 29 partial response (PR) patients (14.8%). Until October 1, 2023, no difference was found in 5-year overall survival (5-OS) and 5-year progression free survival(5-PFS) between allo-HSCT and auto-HSCT (5-OS 57.9% vs. 36.7%, P = 0.139, 5-year PFS 49.4% vs. 28.6%, P = 0.078) for patients who achieved CR, for patients who achieved PR, allo-HSCT recipients had higher 5-OS compared with chemo alone recipients (5-OS 23.8% vs. 0, P = 0.042). For patients undergoing allo-HSCT, minimal residual disease (MRD) negative population showed better 5-OS survival compared with MRD positive patients (67.8% vs. 19.6%, p = 0.000). There were no significant differences between early T-cell precursor (ETP), NON-ETP patients with or without expression of one or more myeloid-associated or stem cell-associated (M/S+) markers (NON-ETP with M/S+, NON-ETP without M/S+) groups in allo-HSCT population for 5-OS. (62.9% vs. 54.5% vs.48.4%, P > 0.05). Notch mutations were more common in patients with non-relapsed/refractory disease than relapsed/refractory disease (χ² =4.293, P = 0.038). In conclusion, Allo-HSCT could be an effective consolidation therapy not just for patients with CR, but also for those who achieved PR. The prognosis is significantly improved by obtaining MRD negative prior to allogeneic transplantation.

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Data availability

Data supporting this study are not publicly available due to ethical reasons. Patients’ baseline data and treatment regimens were extracted from their medical records, follow-up of patients was carried out by searching the medical record or a telephone call. Please contact hongmeijing@bjmu.edu.cn.

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Acknowledgements

This work was supported by the special fund of the National Clinical Key Specialty Construction Program, P. R. China (2023).

Funding

This work was supported by the special fund of the National Clinical Key Specialty Construction Program, P. R. China (2023).

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Authors and Affiliations

  1. Department of hematology, Peking University Third Hospital, 49 North. Huayuan Road, Beijing, 100191, China

    Lan Luo, Yan Li, Ping Yang, Jinjie Gao, Jijun Wang, Fei Dong, Xiaoyan Ke & Hongmei Jing

  2. Institute of Hematology and Blood Diseases Hospital, National Clinical Research Center for Blood Diseases, State Key Laboratory of Experimental Hematology, Chinese Academy of Medical Sciences, Tianjin, 300020, China

    Yang Jiao, Wenyang Huang & Dehui Zou

  3. Department of Hematology, Medical School of Chinese PLA, Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China

    Sai Huang & Chunji Gao

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  1. Lan Luo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by L.L., Y.J., Y.L., P.Y., J.G., S.H., W.H., J.W., F.D., X.K., D.Z., C.G., and H.J. The first draft of the manuscript was written by L.L. H.J. critically revised and interpreted the work. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chunji Gao or Hongmei Jing.

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Ethical approval

The study was approved by the medical Ethics Committee of the Peking University Third Hospital, the Chinese People’s Liberation Army (PLA) General Hospital and the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences.

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The authors declare no competing interests.

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Luo, L., Jiao, Y., Li, Y. et al. Efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation treatment for adolescent and adult Tlymphoblastic leukemia /lymphoma: a large cohort multicenter study in China. Ann Hematol 103, 2073–2087 (2024). https://doi.org/10.1007/s00277-024-05719-7

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