Auto-HSCT in Ph-ALL: A retrospective analysis by the Acute Leukemia Working Party of the EBMT

The Acute Leukemia Working Party (ALWP) of the EBMT reported a decrease in the number of autologous HSCTs (auto-HSCTs) used in patients with ALL, particularly those with Ph-ALL.¹ The role of auto-HSCTs in ALL remains controversial, with limited evidence on differences between transplant outcomes in BCP-ALL and TCP-ALL.² A retrospective analysis by the ALWP, evaluating the outcomes of auto-HSCT and identifying prognostic factors in patients with Ph-ALL, was published by Swoboda et al. in BMC Cancer.² 

Patients diagnosed with BCP-ALL (n = 247) and TCP-ALL (n = 453) who received their first auto-HSCTs in their first CR between 1999 and 2020 were included in the analysis. The study endpoints were LFS, OS, RI, and NRM.²

Key learnings 

The 2-year probabilities for OS, LFS, RI, and NRM were 66.8%, 56%, 39.3%, and 4.8%, while 5-year probabilities were 53.3%, 46.3%, 46.8%, and 6.9%, respectively. 

In MVA, TCP-ALL was associated with reduced risk of relapse (HR, 0.7; p = 0.006), and improved LFS (HR, 0.76; p = 0.023) and OS (HR, 0.75; p = 0.024) compared with BCP-ALL. 

Older age was associated with higher NRM (HR, 1.49; p < 0.001), and worse LFS (HR, 1.1; p = 0.01) and OS (HR, 1.17; p = 0.001).

A longer period from diagnosis to auto-HSCT was associated with a lower risk of relapse (HR, 0.95; p = 0.018), and improved LFS (HR, 0.95; p = 0.01) and OS (HR, 0.94; p = 0.013).

The findings demonstrate that auto-HSCT is well-tolerated in patients with Ph-ALL. It has the potential to be a valuable option in TCP-ALL, but further investigation through prospective trials is warranted.