Outcome for Children and Young Adults With T-Cell ALL and Induction Failure in Contemporary Trials
Elizabeth A. Raetz, Paola Rebora, Valentino Conter, Martin Schrappe, Meenakshi Devidas, Gabriele Escherich, Chihaya Imai, Barbara De Moerloose, Kjeld Schmiegelow, Melissa Burns, Sarah Elitzur, Rob Pieters, Andishe Attarbaschi, Allen Eng Juh Yeoh, Ching‐Hon Pui, Jan Starý, Gunnar Cario, Nicole Bodmer, Anthony V. Moorman, Barbara Buldini, Ajay Vora, Maria Grazia Valsecchi
Abstract
PURPOSE: Historically, patients with T-cell acute lymphoblastic leukemia (T-ALL) who fail to achieve remission at the end of induction (EOI) have had poor long-term survival. The goal of this study was to examine the efficacy of contemporary therapy, including allogeneic hematopoietic stem cell transplantation (HSCT) in first remission (CR1). METHODS: Induction failure (IF) was defined as the persistence of at least 5% bone marrow (BM) lymphoblasts and/or extramedullary disease after 4-6 weeks of induction chemotherapy. Disease features and clinical outcomes were reported in 325 of 6,167 (5%) patients age 21 years and younger treated in 14 cooperative study groups between 2000 and 2018. RESULTS: = .10, respectively. CONCLUSION: Outcomes for patients age 21 years and younger with T-ALL and IF have improved in the contemporary treatment era with a DFS benefit among those undergoing HSCT in CR1. However, outcomes still lag considerably behind those who achieve remission at EOI, warranting investigation of new treatment approaches.