Authors: M. Kurt Yuksel, G. Cengiz Seval, S. Civriz Bozdag, S. K. Toprak, P. Topcuoglu, O. Arslan, O. Muhit, T. Demirer, H. Akan, M. Beksac, O. İlhan, G. Gurman
Published: 2019-06-17
DOI: 10.1097/01.hs9.0000567948.68727.fe
Source: Full article
Background:Adult ALL is a rare disease, T‐ALL accounts for nearly %20 of all ALL and T‐ALL is more common in adults than children. The use of pediatric intensive chemotherapy regimens in AYAs and nelarabine for relapsed and refractory diseases has improved outcomes. Still, allogeneic SCT remains an important component of treatment. Nevertheless relapse is inevitable.Aims:Aim of this study is to evaluate the effect of nelarabine as salvage therapy after HSCT, in terms of disease control, GVHD, PFS and OS.Methods:Between 2014‐2018 Nine (F/M = 1/8; median age = 28 years (21‐45)) patients,from one center are evaluated retrospectively. None of them received nelarabine, before HSCT. Transplantation characteristics are given in table 1. Patients were treated at the time of relapse with nelarabine alone 1.5 g/M2/day on days 1, 3, 5 every 28 days.Results:Among the 9 patients 67% achieved hematologic remission during 8.2 months (range; 2.9‐19.2 mos) follow‐up. The features of nelarabine based salvage therapy are shown in table 2. The main toxicity was neurological and involved 22% of patients. At 1 year, disease‐ free and overall survival rates were 66.7% and 50% respectively (Figure 1). Only one patient (11%) received DLI and MRD was lost. On the other hand patients who had MRD (4 (44%)) and received nelarabine had a stable MRD disease those did not transform to overt leukemia.Summary/Conclusion:The OS at 1 year for salvage treatment with nelarabine at first and secondary relapse is 28%, which is lower than nelarabin usage after HSCT (50%). There is no data about interaction between immune reconstitution, relapse prevention and nelarabine after HSCT. Nelarabine is a well‐tolerated drug with minimal toxicity and can be considered for maintenance therapy post HSCT in both MRD positive, bulky and CNS disease. Even though it does not show graft versus tumor effect, it can just prevent T‐ALL transform to an aggressive leukemia.image