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Chalandon Y, Rousselot P, Chevret S, Cayuela JM, Kim R, Huguet F, Chevallier P, Graux C, Thiebaut-Bertrand A, Chantepie SP, Thomas X, Vincent L, Berthon C, Hicheri Y, Raffoux E, Escoffre-Barbe M, Plantier I, Joris M, Turlure P, Pasquier F, Belhabri A, Roth Guepin G, Blum S, Gregor M, Lafage-Pochitaloff M, Quessada J, Lheritier V, Clappier E, Boissel N, Dombret H. Nilotinib with or without cytarabine for Philadelphia positive acute lymphoblastic leukemia. Blood 2024:blood.2023023502. [PMID: 38452207 DOI: 10.1182/blood.2023023502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
We previously demonstrated that a reduced-intensity chemotherapy schedule can safely replace Hyper-CVAD cycle 1 when combined with imatinib in adults with Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL). In the present randomized GRAAPH-2014 trial, we used nilotinib and addressed the omission of cytarabine (Ara-C) in consolidation. The primary objective was the major molecular response (MMR) rate measured by BCR::ABL1 quantification after cycle 4 (end of consolidation). All patients were eligible for allogeneic stem cell transplant (SCT), whereas those in MMR could receive autologous SCT, followed by 2-year imatinib maintenance in both cases. After the enrollment of 156 out of 265 planed patients, the data and safety monitoring board decided to hold the randomization due to an excess of relapse in the investigational arm. Among the 155 evaluable patients, 77 received Ara-C during consolidation (arm A) and 78 did not (arm B). Overall, 133 (85%) patients underwent SCT, 93 allogeneic, 40 autologous. The non-inferiority endpoint regarding MMR was reached with 71.1% (arm A) and 77.2% (arm B) of patients reaching MMR. However, the 4-year cumulative incidence of relapse was higher in arm B as compared to arm A (31.3% [95% CI, 21.1-41.9%] versus 13.2% [95% CI, 6.7-21.9%]; p=0.017), which translated in a lower relapse-free survival. With a median follow-up of 3.8 years, 4-year overall survival (OS) was 79.0% (95% CI, 70.6-89.3%) in arm A versus 73.4% (95% CI, 63.9-84.4%) in arm B (p=0.35). Despite a non-inferior rate of MMR, more relapses were observed when ARA-C was omitted without impact on survival. ClinicalTrials.gov ID, NCT02611492.
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Affiliation(s)
| | - Philippe Rousselot
- Centre Hospitalier de Versailles, Université Paris-Saclay, Versailles, France
| | - Sylvie Chevret
- 4 APHP, Hôpital Saint-Louis, Service de médecine nucléaire, Paris, France ;, Paris, France
| | - Jean-Michel Cayuela
- University Hospital Saint-Louis, APHP and Université Paris Cité, Paris, France
| | - Rathana Kim
- Université Paris Cité - Hopital Saint-Louis APHP - INSERM U944, PARIS, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sabine Blum
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Orvain C, Chantepie S, Thomas X, Escofrre-Barbe M, Huguet F, Desbrosses Y, Guillerm G, Uzunov M, Leguay T, Barbieux S, Vey N, Chevallier P, Malfuson JV, Lepretre S, Baumann M, Aykut M, Chaib A, Joris M, Zerazhi H, Stussi G, Chapiro J, Berthon C, Bonmati C, Jourdan E, Carp D, Marcais AR, Gallego-Hernanz MP, Vaida I, Bilger K, Villate A, Pasquier F, Chalandon Y, Maury S, Lheritier V, Ifrah N, Dombret H, Boissel N, Hunault-Berger M. Impact of central nervous system involvement in adult patients with Philadelphia-negative acute lymphoblastic leukemia: a GRAALL-2005 study. Haematologica 2023; 108:3287-3297. [PMID: 36891751 PMCID: PMC10690907 DOI: 10.3324/haematol.2022.282332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
Whereas the prognosis of adult patients with Philadelphia-negative acute lymphoblastic leukemia (ALL) has greatly improved since the advent of pediatric-inspired regimens, the impact of initial central nervous system (CNS) involvement has not been formerly re-evaluated. We report here the outcome of patients with initial CNS involvement included in the pediatric-inspired prospective randomized GRAALL-2005 study. Between 2006 and 2014, 784 adult patients (aged 18-59 years) with newly diagnosed Philadelphia-negative ALL were included, of whom 55 (7%) had CNS involvement. In CNSpositive patients, overall survival was shorter (median 1.9 years vs. not reached, HR=1.8 [1.3-2.6], P<0.001). While there was no statistical difference in cumulative incidence of relapse between CNS+ and CNS- patients (HR=1.5 [0.9-2.5], P=0.11), non-relapse mortality was significantly higher in those with initial CNS disease (HR=2.1 [1.2-3.5], P=0.01). This increase in toxicity was mostly observed in patients randomized to the high-dose cyclophosphamide arm and in those who received allogeneic stem cell transplantation. Exploratory landmark analyses did not show any association between either cranial irradiation or allogeneic stem cell transplantation and outcome. Despite improved outcome in young adult ALL patients with pediatric-inspired protocols, CNS involvement is associated with a worse outcome mainly due to excess toxicity, without improved outcome with allogeneic SCT.
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Affiliation(s)
- Corentin Orvain
- Maladies du Sang, CHU d'Angers, Angers, France; Federation Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL; Universite d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Universite, CRCI2NA, F-49000 Angers
| | | | - Xavier Thomas
- Hematologie Clinique, HCL, Centre Hospitalier Lyon Sud, Pierre Benite
| | | | - Francoise Huguet
- Hematologie, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole
| | | | | | | | - Thibaut Leguay
- Hematologie Clinique, Hopital du Haut-Leveque, CHU de Bordeaux, Pessac
| | - Sarah Barbieux
- Hematologie Clinique, Centre Hospitalier de Dunkerque, Dunkerque
| | - Norbert Vey
- Hematologie Clinique, Institut Paoli-Calmettes, Marseille
| | | | | | | | - Michael Baumann
- Klinik fur Med. Onkologie und Hamatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern
| | - Murat Aykut
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Klinik fur Medizinische Onkologie und Hamatologie, Universitatsspital Zurich, Zurich
| | - Abdelaziz Chaib
- Hemato-Oncologie et Medecine Interne, Centre Hospitalier du Pays d'Aix, Aix-en-Provence
| | | | - Hacene Zerazhi
- Hematologie Clinique, Centre Hospitalier Henri Duffaut, Avignon
| | - Georg Stussi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Clinica di Ematologia, Istituto oncologico della Svizzera Italiana, Bellinzona
| | | | | | | | | | - Diana Carp
- Oncologie Medicale, Centre Hospitalier d'Orleans, Orleans
| | | | | | - Iona Vaida
- Onco-Hematologie, Centre Hospitalier Rene-Dubos, Pontoise
| | - Karin Bilger
- Oncologie et Hematologie, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg
| | - Alban Villate
- Hematologie et Therapie Cellulaire, CHRU de Tours, Tours
| | - Florence Pasquier
- Departement d'Hematologie, Gustave Roussy, Universite Paris-Saclay, Villejuif
| | - Yves Chalandon
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department of Oncology, Hematology Division, University Hospital of Geneva and Faculty of Medicine of Geneva, Geneva
| | - Sebastien Maury
- Departement d'Hematologie, Assistance Publique-Hopitaux de Paris (AP-HP), Hopital Henri Mondor, Creteil
| | | | - Norbert Ifrah
- Maladies du Sang, CHU d'Angers, Angers, France; Federation Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL; Universite d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Universite, CRCI2NA, F-49000 Angers
| | - Herve Dombret
- Hematologie Adulte, Hopital Saint-Louis, AP-HP, Paris
| | | | - Mathilde Hunault-Berger
- Maladies du Sang, CHU d'Angers, Angers, France; Federation Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL; Universite d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Universite, CRCI2NA, F-49000 Angers.
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Cabannes-Hamy A, Brissot E, Leguay T, Huguet F, Chevallier P, Hunault M, Escoffre-Barbe M, Cluzeau T, Balsat M, Nguyen S, Pasquier F, Alexis M, Lheritier V, Pastoret C, Delabesse E, Clappier E, Dombret H, Boissel N. High tumor burden before blinatumomab has a negative impact on the outcome of adult patients with B-cell precursor acute lymphoblastic leukemia. A real-world study by the GRAALL. Haematologica 2022; 107:2072-2080. [PMID: 35263986 PMCID: PMC9425331 DOI: 10.3324/haematol.2021.280078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Blinatumomab is a bispecific T-cell engager approved for B-cell precursor acute lymphoblastic leukemia (B-ALL) with persistent minimal residual disease (MRD) or in relapse. The prognostic impact of tumor load has been suggested before other immunotherapies but remains poorly explored before blinatumomab. We retrospectively analyzed the outcome of 73 patients who received blinatumomab either in first complete remission (CR) with MRD (n=35) or at relapse (n=38). Among MRD patients, 91% had MRD >0.01% before blinatumomab, and 89% achieved complete MRD response after blinatumomab. High pre-blinatumomab MRD levels were associated with shorter relapse-free survival (P=0.049) and overall survival (OS) (P=0.011). At 3 years, OS was 33%, 58% and 86% for pre-blinatumomab MRD >1%, between MRD 0.1-1% and <0.1% respectively. Among relapsed patients, 23 received blinatumomab with overt relapse and 15 were in complete response (CR) after bridging chemotherapy. At 3 years, overall CR rate was 68% and complete MRD response rate was 84%. Patients who directly received blinatumomab had shorter relapse-free survival (P=0.033) and OS (P=0.003) than patients bridged to blinatumomab. Three-year OS was 66% in the latter group compared to 16% in the former group. Our observations suggest that pre-blinatumomab tumor burden should help to design more tailored strategies including tumor load reduction in relapsed patients.
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Affiliation(s)
| | - Eolia Brissot
- Sorbonne Université, AP-HP, Saint-Antoine Hospital, Hematology Department, UMRS 938, INSERM,Paris
| | | | | | | | | | | | | | - Marie Balsat
- Hematology Departement, Lyon Sud Hospital, Pierre Benite
| | | | | | - Magda Alexis
- Hematology Departement, Orléans Hospital, Orléans
| | | | | | | | | | - Herve Dombret
- Adult Hematology Department, Saint-Louis Hospital, APHP, URP3518, Institut de Recherche Saint-Louis, Université de Paris, Paris
| | - Nicolas Boissel
- Hematology Adolescent and Young Adult Unit, Saint-Louis Hospital, APHP, URP3518, Institut de Recherche Saint-Louis, Université de Paris, Paris.
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Asnafi V, Buzyn A, Thomas X, Huguet F, Vey N, Boiron JM, Reman O, Cayuela JM, Lheritier V, Vernant JP, Fiere D, Macintyre E, Dombret H. Impact of TCR status and genotype on outcome in adult T-cell acute lymphoblastic leukemia: a LALA-94 study. Blood 2005; 105:3072-8. [PMID: 15637138 DOI: 10.1182/blood-2004-09-3666] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AbstractPatients with T-cell acute lymphoblastic leukemias (T-ALLs) within the Leucémies Aiguës Lymphoblastiques de l'Adulte-94 (LALA-94) prospective trial were treated with a 4-drug per 4-week induction, with intermediate-dose cytarabine and mitoxantrone salvage treatment for patients not achieving complete remission (CR) in 1 course. Only the latter received allografts, if possible, thus providing an informative setting for assessing early response. Representative patients with T-ALL (91 patients) were classified into surface T-cell receptor (TCR)–expressing T-ALL patients (TCRαβ+ or TCRγδ+), pre-αβ T-ALL patients (cTCRβ+, TCR–), and immature (IM) cTCRβ–, TCR– T-ALL patients; 81 patients underwent genotyping for SIL-TAL1, CALM-AF10, HOX11, and HOX11L2. Overall, CR was obtained in 81 (89%) patients; relapse rate was 62% at 4 years and overall survival (OS) rate was 38%. CR rate was significantly lower in IM T-ALL patients after 1 course (45% vs 87%; P < .001) and after salvage (74% vs 97%; P = .002), with the latter inducing a higher rate of CR (9 [64%] of 14) than initial induction. Once CR was obtained, cumulative relapse rates were similar for IM, pre-αβ, and TCR+ T-ALL patients (P = .51), but were higher in HOX11L2 (83%) and SIL-TAL1 (82%) T-ALL patients compared with other genetic subgroups (48%; P = .05). This was associated with an inferior OS for HOX11L2 T-ALLs (13% vs 47% in HOX11L2-T-ALLs; P = .009). The majority of patients with HOX11 T-ALL underwent allografting, predominantly in second CR, but were not associated with a superior OS. Both TCR and genotypic stratification can therefore contribute to risk-adapted management of adult T-ALLs.
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Affiliation(s)
- Vahid Asnafi
- Department of Hematology, Necker-Enfants-Malades, Saint Louis, France
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