Incidence, treatment and outcome of central nervous system relapse in adult acute lymphoblastic leukaemia patients treated front‐line with paediatric‐inspired regimens: A retrospective multicentre Campus ALL study. (6th November 2022)

• Record Type: Journal Article
• Authors: Dargenio, Michelina; Bonifacio, Massimiliano; Chiaretti, Sabina; Vitale, Antonella; Fracchiolla, Nicola Stefano; Papayannidis, Cristina; Giglio, Fabio; Salutari, Prassede; Audisio, Ernesta; Scappini, Barbara; Zappasodi, Patrizia; Defina, Marzia; Forghieri, Fabio; Scattolin, Anna Maria; Todisco, Elisabetta; Lunghi, Monia; Guolo, Fabio; Del Principe, Maria Ilaria; Annunziata, Mario; Lazzarotto, Davide; Cedrone, Michele; Pasciolla, Crescenza; Imovilli, Annalisa; Tanasi, Ilaria; Trappolini, Silvia; Cerrano, Marco; La Starza, Roberta; Krampera, Mauro; Di Renzo, Nicola; Candoni, Anna; Pizzolo, Giovanni; Ferrara, Felicetto; Foà, Robin;
• Is Part Of: British journal of haematology. Volume 200:Number 4(2023)
• Page Start: 440
• Page End: 450
• Publication Date: 2022-11-06
• Subjects: adult ALL -- CNS relapse -- paediatric‐like regimens; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.18537
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Within the Campus ALL network we analyzed the incidence, characteristics, treatment and outcome of a central nervous system (CNS) relapse in 1035 consecutive adult acute lymphoblastic leukemia (ALL) patients treated frontline with pediatric‐inspired protocols between 2009 and 2020. Seventy‐one patients (6.8%) experienced a CNS recurrence, more frequently in T‐ (28/278; 10%) than in B‐ALL (43/757; 5.7%) ( p = 0.017). An early CNS relapse—< 12 months from diagnosis—was observed in 41 patients. In multivariate analysis, risk factors for early CNS relapse included T‐cell phenotype ( p = <0.001), hyperleucocytosis >100 × 10 9 /L ( p <0.001) and male gender ( p = 0.015). Treatment was heterogeneous, including chemotherapy, radiotherapy, intrathecal therapy and novel agents. A complete remission (CR) was obtained in 39 patients (55%) with no differences among strategies. After CR, 26 patients underwent an allogenic transplant, with a significant overall survival benefit compared to non‐transplanted patients ( p = 0.012). After a median observation of 8 months from CNS relapse, 23 patients (32%) were alive. In multivariate analysis, the time to CNS relapse was the strongest predictor of a lower 2‐year post‐relapse survival ( p <0.001). In conclusion, in adult ALL the outcome after a CNS relapse remains very poor. Effective CNS prophylaxis remains the best approach and allogenic transplant should be pursued when possible.