Shinshu Med J, 71⑸：257～267, 2023

Attaining Complete Remission May Confer a Better Outcome after
Allogeneic Hematopoietic Stem Cell Transplantation in
Adult Patients with Acute B-cell Lymphoblastic Leukemia
Sayaka Nishina1）, Hitoshi Sakai1）, Kaoko Sakai1）, Toru Kawakami1）
Fumihiro Kawakami1）, Shuji Matsuzawa1）, Toshiro Ito1）2） and Hideyuki Nakazawa1）＊
1） Department of Hematology and Medical Oncology, Shinshu University School of Medicine
2） Center of Hematology, Matsumoto Medical Center

Introduction : Treatment outcome of adult patients with acute B-cell lymphoblastic leukemia (ALL) is suboptimaleven after an allogeneic hematopoietic stem cell transplantation (allo-HSCT). To maximize the efficacies of thistreatment strategy, risk stratification is crucial.
Methods : We retrospectively collected clinical data of the adult patients with allo-HSCT for ALL at a single in­sitiution in Japan between 2003 and 2022. Univariate and multivariate analyses were performed to identify risk
factors for overall survival (OS), progression-free survival (PFS) and GVHD-free-and-relapse-free survival (GRFS)
at 3 years.
Results : A total of 58 patients were included with 34 females and a median age of 39. Sixty-two percent ofpatients harbored high-risk cytogenetic features or Philadelphia chromosome (Ph). Hematologic complete response(CR) rate was 93 ％ after a first induction, but 75.9 ％ were in CR at allo-HSCT. Blinatumomab was used in 1.7 ％of patients. A chimeric mRNA had been detected in 4 of 26 patients at allo-HSCT. The 3-year OS, PFS andGRFS were 72.7 ％, 54.7 ％ and 46.2 ％, respectively. Pre-transplantation CR was an independent risk factor.
Discussion/Conclusions : Our results imply that a better OS may potentially be achieved by improved pretransplantation CR rate with more frequent application of novel agents. Shinshu Med J 71 : 257―267, 2023
(Received for publication March 6, 2023 ; accepted in revised form April 21, 2023)
Key words : acute lymphoblastic leukemia, allogeneic stem cell transplantation, prognostic risk factor,
adult patienttion (allo-HSCT) has been considered historically as a

Ⅰ Introduction

curative approach for all eligible adult patients with

Acute B-cell lymphoblastic leukemia (ALL) in adult

ALL with high-risk features or ALL in second com­patients remains a challenging disease to treat, withplete remission (CR2) or greater4）-7）. Indeed, up to

suboptimal long-term survival rates, lagging behind

50 ％ of adult patients with ALL received allo-HSCT

those in pediatric patients, where 90 ％ of cure rates

according to real-world data8）. However, despite re­are seen1）2）. The increased risk of relapse has led tocent advances in the prevention and control of toxic­3）

poorer treatment outcomes in ALL , and consolida­

ities of allo-HSCT9）-19）, many cases still fail to betive allogeneic hematopoietic stem cell transplanta­

cured after transplantation, emphasizing the need to
identify pre-transplantation prognostic risk factors in＊

Corresponding author : Hideyuki Nakazawa
Department of Hematology and Medical Oncology,
Shinshu University School of Medicine, 3-1-1 Asahi,
Matsumoto, Nagano 390-8621, Japan
E-mail : hnaka@shinshu-u.ac.jp

No. 5, 2023

patients who receive allo-HSCT.
We herein report the result of a retrospective studyof allo-HSCT in adult patients with ALL performed
at a single institution over the past 20 years. These257

Nishina・Sakai H・Sakai K et al.

retrospective data will provide a database for a his­also adopted at the discretion of the transplantation

torical control to advance the field of treatment forteam members of the department. Total-body irradi­

ALL in the adult population.

ation (TBI) of 2 Gy was allowed to be added to a con­Ⅱ
Ａ

Patients and Methods

ditioning regimen to augment the likelihood of en­
graftment. Any disagreement on treatment plans
was resolved by discussion among the team. Prophy­

Patients
Patients who received allo-HSCT for ALL at thelaxis for graft-versus-host disease (GVHD) was ei­

Department of Hematology of Shinshu University

ther a combination of calcineurin inhibitor and short

Hospital, Matsumoto, Japan, between 2003 and 2022

methotrexate for BM or peripheral blood (PB) trans­

were enrolled. Patients under 16 years old wereplantations, or a combination of tacrolimus and myco­excluded. The diagnosis of ALL was confirmed inphenolate mofetil (MMF) for cord blood (CB) trans­thaccordance with the Revised 4 Edition of the WHO

plantation. A rabbit anti-thymocyte immunoglobulin

Classification of Tumours of Haematopoietic and(ATG) at 2 mg/kg was allowed to be administered

Lymphoid Tissues20）. Real-time quantitative poly­

on day -1 or -2 if severe GVHD was anticipated be­

merase chain reaction (RT-PCR) was performed withcause of an HLA disparity between donor and recipi­mRNA from the bone marrow (BM) cells, if available,

ent. Prophylaxis for infections included Levofloxacin

to screen for chimeric mRNA (Major BCR-ABL1,

500 mg daily from day -7 until neutrophil engraft­minor BCR-ABL1, PML-RARA, RUNX1-RUNX1T1,

ment, and Acyclovir 200 mg twice daily and Fluco­

CBFB-MYH11, DEK-NUP214, NUP98-HOXA9,

nazole 200 mg daily from day -7 until a month afterETV6-RUNX1, TCF3-PBX1, STIL-TAL1, KMT2A-

the cessation of GVHD prophylaxis or treatment. Flu­

AFF1, KMT2A-AFDN, KMT2A-MLLT3, and KMT2A-

conazole was replaced by Voriconazole 200 mg twice

MLLT1). Patients with T-cell acute lymphoblastic

daily or Posaconazole 300 mg twice daily when reno­

leukemia, mixed lineage leukemia, and lymphoidvations were started at different wards in the same

blastic crisis from chronic myelogenous leukemia

hospital building in August 2021. Sulfamethoxazole

were excluded from this study. If a patient under­

400 mg and Trimethoprim 80 mg daily were pre­went multiple transplantations, only the data ob­

scribed soon after the day of neutrophil engraftment

tained during the first allo-HSCT procedure wereuntil a month after the cessation of GVHD prophylaxis

included in the analysis. Relevant clinical data wereor treatment. Anti-epileptic agents were administeredretrieved from their charts. Hematologic complete

prophylactically when busulfan was included in a con­remission (CR) was defined as meeting all of theditioning regimen.

following responses : ＜5 ％ blasts in the BM, abso­Ｃ

Statistical analyses

lute neutrophil count ＞1,000/μL in the peripheral

The primary endpoints were the 3-year overall sur­blood, platelets ＞100,000/μL without transfusion sup­vival (OS), 3-year progression-free survival (PFS), andport, and no extramedullary disease. The BM cells

GVHD-free and relapse-free survival (GRFS) at 3 years

before allo-HSCT were subjected to the RT-PCR toafter allo-HSCT. The OS was defined as the period

detect residual disease if a sample was available in aof time between the date of allo-HSCT and the datepatient with measurable chimeric mRNA at theof death due to any cause, and the PFS was defineddiagnosis.

as the period of time between the date of allo-HSCT

Ｂ

and the date of disease progression. The GRFS was

Transplantation
All transplantation procedures were performed atdefined as the time after allo-HSCT in the absence of

the Department of Hematology, Shinshu University

grade Ⅲ-Ⅳ acute GVHD, chronic GVHD that required

Hospital. Myeloablative conditioning (MAC) regimens

systemic treatment, relapse, and death21）. The proba­

were generally preferred for tolerable patients, butbilities of the OS, PFS and GRFS were estimatedreduced intensity conditioning (RIC) regimens werewith the Kaplan-Meier method. A log-rank test was

258

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ol. 71

Prognosis of adult B-ALL
Table 1

Patient characteristics (n＝58)

Median Age [range]

39.5 [17-70] years old

Sex

24 (41.4％)
34 (58.6％)
8,725 [660-575,550]
36 (62.1％)
16 (27.6％)
6 (10.3％)

Male
FemaleMedian WBC at Dx [range]＜30,000/μL≥ 30,000/μL
NA
Chromosomal Abnormality
Ph1high risk
Pre-HSCT Treatment
TKIs
Blinatumomab
ALL at allo-HSCT
1st CR
2nd CR
non-CRNAMedian months from Dx to HSCT [range]
Median years of Observation [range]

23 (39.7％)
13 (22.4％)
20 (34.5％)
1 (1.7％)40 (69.0％)
4 (6.9％)9 (15.5％)5 (8.6％)
6.5 [3.2-113.2]
3.7 [0.2-19.2]

Dx, diagnosis ; Ph1, Philadelphia chromosome ; HSCT, hematopoietic stem celltransplantation ; TKI, tyrosin kinase inhibitor ; CR, complete remission ; NA,data not available

used to perform univariate comparisons among sub­present study were excluded from the dataset usinggroups. The Cox proportional hazard model with aan opt-out method. This study was conducted withbackward selection method was used to identify in­approval by the institutional review board of Shinshu

dependent variables for the OS, PFS and GRFS. As

University School of Medicine (Approval number :the secondary endpoints, cumulative incidences of5748).

non-relapse mortality (NRM), ALL relapse, and acuteⅢand chronic GVHD were estimated. The results were
described with hazard ratios and their 95 ％ confi­

Ａ

Results

Patients

dence intervals (95 ％ CIs). All tests were two-sided,

A total of 58 patients were included in this analysis

and a p value ＜0.05 was considered to indicate sta­

(Table 1). They were 24 males and 34 females with atistical significance.

median age (range) of 39.5 (17.0-70.0) years old at the

All statistical analyses were performed with EZRtime of allo-HSCT. The median (range) of the whiteversion 1.61, available at Saitama Medical Center, Jichi

blood cell (WBC) count at the diagnosis was 8,725

Medical University, Saitama, Japan (https://www.

(660-575,550) /μL. High-risk genetic features for ALL

jichi.ac.jp/saitama-sct/SaitamaHP.files/statmedEN.

were found in 13 patients (22.4 ％), including harbor­html), which is a graphical user interface for R (Theing 11q23 abnormality (n＝3), hypodiploidy (chromo­

R Foundation for Statistical Computing, Vienna,

somes＜45) (n＝1), and a complex karyotype (pres­

Austria). More precisely, it is a modified version ofence of ≥ 5 aberrations) (n＝9). Twenty-three patients

the R commander designed to add statistical func­

tested positive for Philadelphia chromosome p210 (n22）

tions frequently used in biostatistics .

＝2), p190 (n＝20), and unknown (n＝1). Before allo-

Ｄ

HSCT, 20 patients were treated with tyrosine kinase

Ethical considerations

Patients who did not agree to be included in the
No. 5, 2023

inhibitors (imatinib [n＝8], dasatinib [n＝10], ponatinib
259

Nishina・Sakai H・Sakai K et al.
Table 2

Characteristics of HSCT

Variablesn (％)

Stem Cell Source
Bone Marrow
Peripheral Blood
Cord Blood
Relationship of Donor
relatedunrelated
Donor-Recipient Sex
F to M
M to F
matchedHLA Disparity
matchedmismatchedunknown
Conditioning Intensity
MAC

39 (67.2)
6 (10.3)
13 (22.4)
15 (25.9)
43 (74.1)
10 (17.2)
16 (27.6)
32 (55.2)
31 (53.5)
24 (41.4)
3 (5.2)

TBI-CYintensified TBI-CY
Flu-Bu4±MEL/TBI
RIC
Flu-Bu2±TBI
Flu-MEL±TBI
GVHD Prophylaxis
CsA ＋ short MTX
Tac ＋ short MTX
CsA ＋ MMF
Tac ＋ MMF
ATG

49 (84.5)2218
99 (15.5)
2
7
19 (32.8)
33 (56.9)
7 (12.1)
1 (1.7)6 (10.3)

HSCT, hematopoietic stem cell transplantation ; MAC, myeloablative conditioning ; RIC,
reduced intensity conditioning ; TBI, total body irradiation ; CY, cyclophosphamide ; Flu,
fludarabine ; Bu, busulfan ; MEL, melphalan ; CsA, cyclosporin A ; MTX, methotrexate ;Tac, tacrolimus ; MMF, micofenolate mofetil ; ATG, anti-thymocyte gammaglobulin[n＝2]), and 1 patient was treated with blinatumom­

minor BCR-ABL1, who were in hematological CR (nab. Fifty-four patients (93.1 ％) achieved CR after a＝1), in non-CR (n＝1) and with an unknown hemato­

single course of induction therapy. The disease sta­logical status (n＝1).

tus at the time of allo-HSCT was hematological CR

Ｂ

Transplantation (Table 2)

in 44 patients (75.9 ％), non-CR in 9 patients (15.5 ％)The transplantation graft was from the BM in 39

and unknown in 5 patients (8.6 ％). An analysis of thepatients (67.2 ％), the PB in 6 patients (10.3 ％), and thechimeric mRNA had been available at the diagnosis

CB in 13 patients (22.4 ％). The donor and recipientin 26 patients with ETV6-RUNX1 (n＝1), TCF3-

were unrelated in 43 transplantations (74.1 ％). The

PBX1 (n＝3), KMT2A-AFF1 (n＝3), major BCR-

donor-to-recipient sex parings were female-to-male

ABL1 (n＝2) and minor BCR-ABL1 (n＝17). The

in 10 transplantations (17.2 ％), male-to-female in 16

chimeric mRNA was detected at the time of trans­

transplantations (27.6 ％) and same-sex pairings in 32

plantation in one patient with TCF3-PBX1, who wastransplantations (55.2 ％). Thirty-one transplantationsin hematological non-CR, and three patients with

(53.5 ％) were performed from 8/8 allele-matched do­

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ol. 71

Prognosis of adult B-ALL

nors. The MAC regimen (n＝49, 84.5 ％) was either a

1.3 ％), respectively (Fig. 2a). No significant differenc­

TBI-CY-based regimen (n＝40) or Flu-Bu4-based

es were found between the groups in the incidence

regimen (n＝9). RIC regimens (n＝9, 15.5 ％) were ei­

rates of acute GVHD. The cumulative incidence rates

ther a Fu-Bu2-based regimen (n＝2) or Flu-Mel-of chronic GVHD and chronic GVHD requiring sys­

based regimen (n＝7). TBI (2 Gy) was added as atemic therapy were 48.7 ％ (95 ％ CI : 7.6 ％-34.4 ％)conditioning regimen in 6 patients (10.3 ％). ATG wasand 21.4 ％ (95 ％ CI : 11.2 ％ -38.8 ％ ), respectively

included in GVHD prophylaxis in 6 patients (10.3 ％).

(Fig. 2b). No significant differences were found be­Ｃtween groups in the incidence rates of chronic GVHD.

The OS
The median [range] period of observation was 3.7

The cumulative incidence of relapse was 28.8 ％[0.2-19.2] years. The 3-year OS was 72.7 ％ (95 ％(95 ％ CI : 17.4 ％-41.1 ％) at 3 years (Fig. 2c). Patients

CI : 58.1 ％-82.9 ％) (Fig. 1a). A log-rank univariate

without CR at transplantation had a tendency to­

analysis showed that age of ≥ 40 years old at the time

ward an association with an increased rate of re­of transplantation (p＝0.0324) and non-CR at the time

lapse, but the difference did not reach statistical sig­of transplantation (p＝0.0166) were identified as risk

nificance (p＝0.07).

factors for the OS (Fig. 1b,c). There were no statisti­

The cumulative incidence of non-relapse mortality

cal differences in the OS between patients with allo-(NRM) was 16.7 ％ at 3 years (95 ％ CI : 8.1 ％-27.8 ％)HSCT performed before (n＝35) and after 2013 (n＝(Fig. 2d). A higher rate of NRM was significantly asso­23) (p＝0.406). The results of the multivariate analysis

ciated with age ≥ 40 years old at the time of allo-HSCT

showed that non-CR at allo-HSCT was an indepen­(p＝0.0209) and male sex (p＝0.00795) (Fig. 2e,f).

dent risk factor for the OS with a hazard ratio of

Ｆ

3.254 (95 ％ CI : 1.119-9.459, p＝0.03022).
Ｄ

The PFS and GRFS

Post-transplantation anti-leukemic therapy
Among the 20 patients with relapsed ALL after

allo-HSCT, 17 received anti-leukemic therapies, in­

The 3-year PFS was 54.7 ％ (95 ％ CI : 40.6 ％-66.7

cluding 3 with chemotherapy, 9 with tyrosine kinase％) (Fig. 1d). Patients with residual disease at allo-

inhibitors (imatinib [n＝2], dasatinib [n＝3], ponatinib

HSCT showed a significantly poorer PFS than pa­[n＝5]), and 1 with blinatumomab. Three patients withtients without residual disease (p＝0.00154) (Fig. 1e).

Ph-positive ALL and six patients with Ph-negative

A multivariate analysis indicated that non-CR at the

ALL underwent a second allo-HSCT procedure.

time of transplantation was an independent risk factor
for a poor PFS with a hazard ratio of 3.562 (95 ％ CI :1.539-8.24, p＝0.002998).

Ⅳ

Discussion

The recent development of pediatric-inspired regi­

The 3-year GRFS was 46.2 ％ (95 ％ CI : 23.6 ％-mens, novel anti-leukemic agents, and MRD-driven

58.7 ％) (Fig. 1f). Univariate analyses showed that thetreatment strategies might potentially reduce thestem cell source and non-CR at transplantation weredependence of patients with standard-risk ALL on

associated with the outcome with a statistical signifi­

allo-HSCT, but an increasing number of adult pa­

cance (p＝0.00598 and p＝0.00005, respectively) (Fig.

tients with ALL harboring higher-risk features still

1g,h). A multivariate analysis indicated that non-CR

undergo the transplantation seeking a cure6）23）-28）.

at transplantation was an independent risk factor for

Our results showed a 3-year OS of 72.7 ％ , whicha GRFS with a hazard ratio of 4.746 (95 ％ CI : 2.081-

confirmed the challenges faced by adult patients with

10.82, p＝0.000213).

ALL compared with the more favorable outcomes inＥ Cumulative incidence rates of GVHD, relapse

pediatric patients. Our results also suggested thatand NRM

achieving higher CR rates before allo-HSCT is asso­

The cumulative incidence rates of grade Ⅱ-Ⅳ acuteciated with a better OS in adult recipients.

GVHD and grade Ⅲ-Ⅳ acute GVHD were 46.7 ％A recent study has suggested that adult patients(95 ％ CI : 34.9 ％-60.4 ％) and 5.1 ％ (95 ％ CI : 0.2 ％-with ALL who are MRD-negative prior to allo-HSCT

No. 5, 2023

261

0

1000

3-year OS 72.7%

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BMT
PB
CBT

28
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GRFS
CR
non-CR

Number at risk0

Number at risk
58
29

1.0

7000

1
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(h)

1
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1.0

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0.2

Fig. 1 Kaplan-Meier curves of the overall survival (OS), progression-free survival (PFS), and GVHD-free and relapse-free survival (GRFS).

20
2

5000

10
8

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CR
non-CR

0.4

1

2
0

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3-year PFS 54.7%

CR at the time of transplantation, with statistical significance (p＝0.0324 and p＝0.0166, respectively). (d) The 3-year PFS was 54.7 ％ (95 ％ CI : 40.6 ％-66.7 ％), and a
relatively better PFS was observed in (e) younger patients than in older patients (p＝0.00154). (f) The 3-year GRFS was 46.2 ％ (95 ％ CI : 23.6 ％-58.7 ％) ; a subgroup
analyses showed that the GRFS differed (g) among stem cell sources (p＝0.00598) and (h) by CR status (p＝0.00005). The median [range] period of observation was 3.7[0.2-19.2] years.

(a) The 3-year OS was 72.7 ％ (95 ％ CI : 58.1 ％-82.9 ％) ; a superior OS was observed in (b) relatively young patients (＜40 years old) and (c) patients with hematological44
9Number at risk

4000

Days from allo-HSCT

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3-year GRFS 46.2%

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0.2

OS

p=0.0166

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(g)

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Number at risk

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< 40 years old≥ 40 years old

0.4

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OS

p=0.0324
Probability(c)Probability

(f)

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CR
non-CR

126000

p=0.00154

PFS

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Probability
Probability(e)Probability

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Probability

(a)

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Nishina・Sakai H・Sakai K et al.

Shinshu Med J

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0.0

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p=0.0209< 40 years old≥ 40 years old

non-relapse mortality

15

Number at risk
58
18

3000

Days from allo-HSCT

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III-IV acute GVHD 5.1%

II-IV acute GVHD 46.7%

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(f)

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p=0.00795

malefemalenon-relapse mortality

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Number at risk
58
17

3000

Days from allo-HSCT

2000

1000

0

0
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chronic GVHD requiring
systemic therapy 21.4%

chronic GVHD 48.7%

Number at risk

(b)

(g)

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Donor to Recipientmale to male
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23

non-relapse mortality

Number at risk
58
29

0
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3-year relapse rate 28.8%

0.6

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Cumulative incidence

1000

Number at risk
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mortality rate 16.7%

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6000

in 16.7 ％. Subgroup comparisons of the cumulative incidence of NRM showed that older age (e) and male sex (f) were associated with a significantly increased NRM(p＝0.0209 and p＝0.00795, respectively). Regarding donor-recipient sex pairings (g), there was a tendency toward a higher NRM in male-to-male pairs, followed byfemale-to-male pairs, male-to-female pairs, and female-to-female pairs, but the differences were not statistically significant (p＝0.0604).

Fig. 2 Cumulative incidence curves of GVHD, disease relapse, and non-relapse mortality (NRM).
(a) Grade Ⅱ-Ⅳ acute GVHD was observed in 46.7 ％, and grade Ⅲ-Ⅳ acute GVHD was observed in 5.1 ％ of the patients. (b) Chronic GVHD was reported in 48.7 ％,and chronic GVHD requiring systemic therapy occurred in 21.4 ％. (c) ALL relapse was observed in 28.8 ％ of cases at 3 years after allo-HSCT, while (d) NRM was seen(e)

Cumulative incidence

Cumulative incidence

Cumulative incidence
Cumulative incidence

No. 5, 2023
Cumulative incidence

1.0

Cumulative incidence

(a)

0

7000

Prognosis of adult B-ALL

263

Nishina・Sakai H・Sakai K et al.

achieve superior outcomes29）. In our cohort, however,in our cohort, although the difference did not trans­

the OS, PFS, and GRFS did not differ markedly be­late into a sex-based difference in the OS, PFS, or

tween the patients (n＝17) who tested negative with

GRFS. We did not find a significant difference between

PCR for chimeric mRNA before transplantation andmale and female patients in such pre-transplantation

the patients (n＝41) in whom the test was not per­factors as age distribution (p＝0.907 with a Mann-

formed at all or the test result was positive (p＝0.83,

Whitney test), the WBC count at the diagnosis (p＝p＝0.231 and p＝0.328, respectively). One possible ex­0.269), frequency of high-risk chromosomal abnor­

planation for the lack of an association is that PCR

mality (p＝1.0), frequency of Philadelphia chromosome

findings were not available in 17 ％ of patients with

(p＝0.586), CR rate at transplantation (p＝0.154), HLA

Ph-positive ALL and 72 ％ of patients with Ph-neg­

disparity (p＝1.0), or conditioning (p＝0.467). Naka­

ative ALL in our cohort due to the retrospective

sone et al. reported that a donor-recipient sex differ­nature of the present study. It should be noted, how­ence may confer different risks of GVHD, different

ever, that the methods used for MRD analysis, either

risks of relapse and non-relapse mortality and a poor

PCR-based or immunophenotyping-based techniques,OS, and the contribution of the risks varies accord­

may vary among institutions worldwide, and that theing to conditioning regimens35）. In our cohort, the cu­

cut-off values are not standardized29）. Nevertheless,mulative incidence of NRM seemed highest in male-recent studies have suggested that a deeper response

to-male transplantation, followed by female-to-male,to an MRD-negative level may be expected withmale-to-female, and female-to-female cases, al­

30）
31）

novel agents such as blinatumomab. Only one ofthe patients with Ph-negative ALL received blinatu­

though the difference did not reach statistical signifi­
cance (p＝0.0604) (Fig. 2g).

momab in our cohort. With the increasing availability

Several limitations associated with the presentof novel therapies MRD negativity is likely to become

study warrant mention. Because of the retrospective

achievable for more patients, hopefully leading to im­nature of the analysis, a detailed description of theproved treatment outcomes among adult ALL pa­

genetic lesions of ALL was lacking in more than 70

31）
32）

tients with or without allo-HSCT％ of the patients with Ph-negative ALL. It is desir­.

A significant difference between the OS and PFS

able to perform genetic analysis of ALL in all patientswas also recognized in our cohort, suggesting that aat the diagnosis, ideally including a genetic lesion such

number of patients refractory to allo-HSCT mightas the Ph-like pattern, which may be incorporated inhave been salvaged by post-HSCT therapies. Indeed,

the assessment of the disease risks as well as intyrosine kinase inhibitors (TKIs) or blinatumomab

exercising an MRD-driven treatment strategy2）7）23）.

were administered after post-HSCT relapses in nine

However, despite all these limitations, this retrospec­

patients with Ph-positive ALL and one with Ph-tive study may provide some historical control data

negative ALL. Second transplantation proceduresfor performing a comparative analysis at our institu­

were performed in three and six patients with Ph-tion in the future.

positive and Ph-negative ALL, respectively. Increas­Ｖing evidence suggests the efficacy of TKIs following

Conclusion

allo-HSCT for patients with Ph-positive ALL, while

In this retrospective analysis of allo-HSCT in 58

a suitable agent has not been identified as mainte­

adult patients with ALL, our results show that at­

33）
34）

. The estab­taining CR before transplantation may be an inde­lishment of maintenance and/or preemptive thera­

pendent risk factor for an improved OS, PFS, andpies is eagerly awaited for transplant recipients with

GRFS. Treatment outcomes with the incorporation of

Ph-negative ALL.

novel agents before and after transplantation shouldnance therapy for Ph-negative ALL

Of note, a significantly increased rate of NRM wasfound in male patients compared with female patients264

be retrospectively compared with this dataset in the
future.
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Prognosis of adult B-ALL

Conflict of Interest
The authors declare that they have no competinginterests.
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（2023. 3. 6 received ; 2023. 4. 21 accepted）

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