Effects of isolated central nervous system involvement evaluated by multiparameter flow cytometry prior to allografting on outcomes of patients with acute lymphoblastic leukemia

Frontiers in Oncology

Oncology

Ying-Jun Chang¹  Feng-Rong Wang¹  Xiao-Jun Huang¹  Yu-Qian Sun¹  Xiao-Dong Mo¹  Yan-Rong Liu¹  Wei Han¹  Huan Chen¹  Kai-Yan Liu¹  Yu-Hong Chen¹  Meng Lv¹  Hao Jiang¹  Lan-Ping Xu¹  Qian Jiang¹  Yu Wang¹  Ling Ma¹  Chen-Hua Yan¹  Jin Lu¹  Fei-Fei Tang¹  Xiao-Hui Zhang¹  Zhi-Dong Wang¹ 

[1] Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China;

关键词: acute lymphoblastic leukemia;    central nervous system involvement;    isolated flow cytometry positive;    allogeneic hematopoietic stem cell transplantation;    transplant outcomes;   

DOI  :  10.3389/fonc.2023.1166990

 received in 2023-02-15, accepted in 2023-04-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionAllogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a major strategy to cure patients with acute lymphoblastic leukemia (ALL). The aim of this study was to evaluate whether isolated flow cytometry (FCM)-positive central nervous system (CNS) involvement before allo-HSCT is clinically significant.MethodsThe effects of isolated FCM-positive CNS involvement prior to transplantation on the outcomes of 1406 ALL patients with complete remission (CR) were retrospectively investigated.ResultsPatients were classified into isolated FCM-positive CNS involvement (n=31), cytology-positive CNS involvement (n = 43), and negative CNS involvement (n = 1332) groups. Among the three groups, the 5-year cumulative incidence of relapse (CIR) values were 42.3%, 48.8%, and 23.4%, respectively (P<0.001). The 5-year leukemia-free survival (LFS) values were 44.7%, 34.9%, and 60.8%, respectively (P<0.001). Compared with the negative CNS group (n=1332), the 5-year CIR of the pre-HSCT CNS involvement group (n=74) was higher (46.3% vs. 23.4%, P<0.001], and the 5-year LFS was inferior (39.1% vs. 60.8%, P<0.001). Multivariate analysis indicated that four variables, T-cell ALL, in second complete remission or beyond (CR2+) at HSCT, pre-HSCT measurable residual disease positivity, and pre-HSCT CNS involvement, were independently associated with a higher CIR and inferior LFS. A new scoring system was developed using the following four variables: low-risk, intermediate-risk, high-risk, and extremely high-risk groups. The 5-year CIR values were 16.9%, 27.8%, 50.9%, and 66.7%, respectively (P<0.001), while the 5-year LFS values were 67.6%, 56.9%, 31.0%, and 13.3%, respectively (P<0.001).ConclusionOur results suggest that ALL patients with isolated FCM-positive CNS involvement are at a higher risk of recurrence after transplantation. Patients with pre-HSCT CNS involvement had higher CIR and inferior survival outcomes.

【 授权许可】

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Copyright © 2023 Ma, Xu, Wang, Zhang, Chen, Chen, Wang, Han, Sun, Yan, Lv, Tang, Mo, Wang, Jiang, Lu, Jiang, Liu, Liu, Chang and Huang