Outcome of 609 adults after relapse of acute lymphoblastic leukemia (ALL); an MRC UKALL12/ECOG 2993 study

Abstract

Most adults with acute lymphoblastic leukemia (ALL) who achieve complete remission (CR) will relapse. We examined the outcome of 609 adults with recurring ALL, all of whom were previously treated on the Medical Research Council (MRC) UKALL12/ECOG2993 study, where the overall survival (OS) of newly diagnosed patients is 38% (95% confidence interval [CI] ‫؍‬ 36%-41%) at 5 years. By contrast, OS at 5 years after relapse was 7% (95% CI ‫؍‬ 4%-9%). Factors predicting a good outcome after salvage therapy were young age (OS of 12% in patients younger than 20 years vs OS of 3% in patients older than 50 years; 2P < .001) and short duration of first remission (CR1) (OS of 11% in those with a CR1 of more than 2 years versus OS of 5% in those with a CR1 of less than 2 years; 2P < .001). Treatment received in CR1 did not influence outcome after relapse. In a very highly selected subgroup of patients who were able to receive HSCT after relapse, some were long-term survivors. We conclude from a large, unselected series with mature follow-up that most adults with recurring ALL, whatever their prior treatment, cannot be rescued using currently available therapies. Prevention of recurrence is the best strategy for long-term survival in this disease. (Blood. 2007;109:944-950)

Translation and Clinical Development of Bispecific T‐cell Engaging Antibodies for Cancer Treatment

“…Among patients in first relapse, a longer duration of remission is associated with a higher probability of response 67, 68, 69. Allogeneic hematopoietic stem cell transplantation (HSCT) is the best‐established treatment following relapse, with efficacy attributed to both conditioning regimens and immunologically mediated graft vs. leukemia effect.…”

Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study

“…[1][2][3] Fewer than 50% of patients, however, are alive 5 years from diagnosis, with the majority of deaths being due to relapsed disease. 3,4 Survival following ALL relapse is dismal, 5 thus a key improvement in outcome may result from optimization of postremission consolidation therapy. Myeloablative conditioned (MAC) allo-SCT improves survival in patients in CR1 in both Ph-positive and negative disease, 6 due to a reduction in the relapse incidence (RI).…”

CART‐cells merge into the fast lane of cancer care

“…Adult patients with relapsed or refractory ALL have a poor prognosis and almost all patients will die from their disease [21][22][23][24][25][26][27][28]. While children are initially more responsive to traditional salvage chemotherapy approaches than adults, these remissions are often not sustained and relapsed ALL remains a leading cause of cancer deaths in children [29,30].…”