Survival outcomes for post-allo-HSCT relapsed ALL by disease lineage and salvage treatment

A retrospective, multicenter UK study evaluated survival outcomes by disease lineage and salvage treatment in adults with post-allogeneic hematopoietic stem cell transplantation (allo-HSCT) relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL), including morphological and measurable residual disease (MRD) relapse. The primary outcomes assessed were overall survival (OS) and progression-free survival (PFS) from the time of R/R diagnosis. Results were published in the British Journal of Haematology by Rampotas et al.

Key data: Patients with T-cell ALL (T-ALL; n = 19) had worse 2-year OS (10.5% vs 43.6%) and PFS (11.4% vs 26.3%) vs those with B-cell ALL (B-ALL; n = 114). Among patients with BCR-ABL1-positive disease who received tyrosine kinase inhibitors (TKIs), 2-year OS was 68.1%, while 2-year PFS was 16.1%. In B-ALL, 2-year OS and PFS were 14.6% and 15.6%, respectively, with blinatumomab; 40.0% and 30.0% with inotuzumab ozogamicin; and 66.2% and 51.2% with chimeric antigen receptor (CAR) T-cell therapy. In B-ALL, morphological relapse was associated with worse OS than MRD-level relapse (HR, 4.38; 95% CI, 1.75–10.98; p = 0.001).

Key learning: In this real-world study, post-allo-HSCT survival outcomes varied by lineage, salvage therapy, and relapse type, with CAR T-cell therapy and TKIs showing the most promise in B-ALL and T-ALL remaining a major unmet need.