Outcome after first relapse post-immunochemotherapy in older adults with Philadelphia-negative B-cell acute lymphoblastic leukemia: A GRAALL study.
Inotuzumab (InO)-based frontline regimens have significantly improved the survival of older patients with Philadelphia-negative (Ph-) B-cell acute lymphoblastic leukemia (B-ALL). Yet, outcome after relapse is not reported for this population.
The retrospective RELAPSINO study describes post-relapse outcome of 48 older patients treated front-line with a combination of InO and low-dose chemotherapy in the EWALL-INO trial (NCT03249870). At relapse (91% medullary), median age was 70 years and median duration of first complete remission (CR1) 15.2 months. CD19 or CD22 expression loss was observed in respectively 13% and 23% of evaluable cases. Most patients (85%) received salvage therapy (blinatumomab, low dose or intensive chemotherapy, in combination or not). There was no InO re-treatment.
Overall, CR2 was reached by 51% of the patients. Median event-free survivals (EFS, 3.2 months) and overall survivals (OS, 4.5 months) were dismal. For patients achieving CR2, 2-year OS was 46% and leukemia-free survival (LFS) was 36%. By multivariable analysis, not receiving intensive chemotherapy was associated with significantly lower EFS (hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.43-7.53, p = .005), LFS (HR, 13.2; 95% CI, 2.46-70.88, p = .003), and OS (HR, 3.25; 95% CI, 1.39-7.59, p = .006). CR1 duration ≥12 months was significantly associated with better EFS (HR, 0.31; 95% CI, 0.14-0.67, p = .003), LFS (HR, 0.16; 95% CI, 0.04-0.72, p = .01), and OS (HR, 0.42; 95% CI, 0.20-0.89, p = .023). Not achieving CR2 was associated with lower OS (HR, 8.0; 95% CI, 3.25-20.1, p < .001). Receiving blinatumomab had no impact.
These results indicate that salvage regimen should be proposed in this context, allowing 50% of patients to achieve CR2 and have better survival.
The retrospective RELAPSINO study describes post-relapse outcome of 48 older patients treated front-line with a combination of InO and low-dose chemotherapy in the EWALL-INO trial (NCT03249870). At relapse (91% medullary), median age was 70 years and median duration of first complete remission (CR1) 15.2 months. CD19 or CD22 expression loss was observed in respectively 13% and 23% of evaluable cases. Most patients (85%) received salvage therapy (blinatumomab, low dose or intensive chemotherapy, in combination or not). There was no InO re-treatment.
Overall, CR2 was reached by 51% of the patients. Median event-free survivals (EFS, 3.2 months) and overall survivals (OS, 4.5 months) were dismal. For patients achieving CR2, 2-year OS was 46% and leukemia-free survival (LFS) was 36%. By multivariable analysis, not receiving intensive chemotherapy was associated with significantly lower EFS (hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.43-7.53, p = .005), LFS (HR, 13.2; 95% CI, 2.46-70.88, p = .003), and OS (HR, 3.25; 95% CI, 1.39-7.59, p = .006). CR1 duration ≥12 months was significantly associated with better EFS (HR, 0.31; 95% CI, 0.14-0.67, p = .003), LFS (HR, 0.16; 95% CI, 0.04-0.72, p = .01), and OS (HR, 0.42; 95% CI, 0.20-0.89, p = .023). Not achieving CR2 was associated with lower OS (HR, 8.0; 95% CI, 3.25-20.1, p < .001). Receiving blinatumomab had no impact.
These results indicate that salvage regimen should be proposed in this context, allowing 50% of patients to achieve CR2 and have better survival.
Authors
Moyer Moyer, Leguay Leguay, Jullien Jullien, Huguet Huguet, Roth-Guepin Roth-Guepin, Hicheri Hicheri, Belhabri Belhabri, Cluzeau Cluzeau, Berceanu Berceanu, Tavernier Tavernier, Leprêtre Leprêtre, Bilger Bilger, Turlure Turlure, Bastié Bastié, Balsat Balsat, Alexis Alexis, Brissot Brissot, Lebon Lebon, Raffoux Raffoux, Wickenhauser Wickenhauser, Cacheux Cacheux, Banos Banos, Bonnet Bonnet, Boissel Boissel, Dombret Dombret, Rousselot Rousselot, Chevallier Chevallier
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