Abstract

Research Article

Haematopoietic Cell Transplants in Adults Acute Lymphoblastic Leukaemia in a Resource-poor Middle East Country

Khalid Halahleh*, Isra Muradi, Nazmi Kamal, Ayat Taqash, Fareed Barakat, Hadeel Abdelkhaleq, Mohammad Khalil, Lina Halahleh, Waleed Da’na, Nidal Almasri, Mohammad Makoseh, Ammar Alamarneh, Al-Far Rozan, Husam Abu-Jazar and Robert Peter Gale

Published: 08 January, 2025 | Volume 9 - Issue 1 | Pages: 006-011

Background: Outcomes of chemotherapy in adults with ALL in resource-poor countries are reportedly worse compared with outcomes in resource-rich countries. There are few comparative data on transplants in these settings.
Methods: Retrospective analysis of 102 consecutive subjects > 18 years with ALL receiving an allotransplant from Jan 2007 to Sept 2022 in Jordan.
Results: Median follow-up is 38 mo ([IQR] 16-80 mo). 81 subjects were men. The median age was 29 y(IQR 22-36 y). 63 were B-cell and 38, were T-cell lineage. 31 had the Ph-chromosome. 68 were in 1st and 34, ≥ 2nd histological complete remission. 97 received intensive conditioning. Donors were an HLA-identical sibling (N = 88) or an HLA-mis-matched relative (N = 14). Grafts were blood cells. Subjects received conventional GvHD prophylaxis, cyclophosphamide (N = 11) or ATG (N = 3). All subjects recovered bone marrow function with complete donor chimerism. 5-year leukemia-free survival (LFS), 58% (47, 69%) and survival, 45% (34, 56%). 45 subjects developed acute and 44, cGvHD. 3-year cumulative incidence of cGvHD was 28% (15, 42%). 5-year CIR was 32% (18, 45%) and 3-year NRM, 25% (15, 35%).
Conclusion: Allotransplant outcomes in adults with ALL in Jordan, a resource-poor country, seem comparable to those reported in resource-rich countries.

Read Full Article HTML DOI: 10.29328/journal.jsctt.1001046 Cite this Article Read Full Article PDF

Keywords:

Stem cell transplantation; ALL; Resource-poor countries; Jordan

References

  1. Bassan R, Bourquin JP, DeAngelo DJ, Chiaretti S. New approaches to the management of adult acute lymphoblastic leukemia. J Clin Oncol. 2018;36:3504–3519. Available from: https://doi.org/10.1200/JCO
  2. DeFilipp Z, Advani AS, Bachanova V, Cassaday RD, Deangelo DJ, Kebriaei P, et al. Hematopoietic cell transplantation in the treatment of adult acute lymphoblastic leukemia: updated 2019 evidence-based review from the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant. 2019;25:2113–2123. Available from: https://doi.org/10.1016/j.bbmt.2019.08.014
  3. Giebel S, Marks DI, Boissel N, Baron F, Chiaretti S, Ciceri F, et al. Hematopoietic stem cell transplantation for adults with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission: a position statement of the European Working Group for Adult Acute Lymphoblastic Leukemia (EWALL) and the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2019;54:798–809. Available from: https://doi.org/10.1038/s41409-018-0373-4
  4. Segal E, Martens M, Wang HL, Brazauskas R, Weisdorf D, Sandmaier BM, et al. Comparing outcomes of matched related donor and matched unrelated donor hematopoietic cell transplants in adults with B-cell acute lymphoblastic leukemia. Cancer. 2017;123:3346–3355. Available from: https://doi.org/10.1002/cncr.30737
  5. Nagler A, Labopin M, Houhou M, Aljurf M, Mousavi A, Hamladji RM, et al. Outcome of haploidentical versus matched sibling donors in hematopoietic stem cell transplantation for adult patients with acute lymphoblastic leukemia: a study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. J Hematol Oncol. 2021;14:53. Available from: https://doi.org/10.1186/s13045-021-01065-7
  6. Wieduwilt MJ, Metheny L, Zhang MJ, Wang HL, Estrada-Merly N, Marks DI, et al. Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia. Blood Adv. 2022;6:339–357. Available from: https://doi.org/10.1182/bloodadvances.2021004916
  7. Kantarjian H, Stein A, Gökbuget N, Fielding AK, Schuh AC, Ribera JM, et al. Blinatumomab versus chemotherapy for advanced acute lymphoblastic leukemia. N Engl J Med. 2017;9:836–847. Available from: https://doi.org/10.1056/nejmoa1609783
  8. Jabbour E, Ravandi F, Kebriaei P, Huang X, Short NJ, Thomas D, et al. Salvage chemoimmunotherapy with inotuzumab ozogamicin combined with mini-hyper-CVD for patients with relapsed or refractory Philadelphia chromosome-negative acute lymphoblastic leukemia: A phase 2 clinical trial. JAMA Oncol. 2018;4:230–234. Available from: https://doi.org/10.1001/jamaoncol.2017.2380
  9. Frey NV. Relapsed ALL: CAR T vs transplant vs novel therapies. Hematology Am Soc Hematol Educ Program. 2021;1:1–6. Available from: https://doi.org/10.1182/hematology.2021000225
  10. Park JH, Rivière I, Gonen M, Wang X, Sénéchal B, Curran KJ, et al. Long-term follow-up of CD19 CAR therapy in acute lymphoblastic leukemia. N Engl J Med. 2018;5:449–459. Available from: https://doi.org/10.1056/nejmoa1709919
  11. Zhao YL, Liu DY, Sun RJ, Zhang JP, Zhou JR, Wei ZJ, et al. Integrating CAR T-cell therapy and transplantation: Comparisons of safety and long-term efficacy of allogeneic hematopoietic stem cell transplantation after CAR T-cell or chemotherapy-based complete remission in B cell acute lymphoblastic leukemia. Front Immunol. 2021;12:605766. Available from: https://doi.org/10.3389/fimmu.2021.605766
  12. Liang EC, Craig J, Torelli S, Cunanan K, Iglesias M, Arai S, et al. Allogeneic hematopoietic cell transplantation for adult acute lymphoblastic leukemia in the modern era. Transplant Cell Ther. 2022;28:490–495. Available from: https://doi.org/10.1016/j.jtct.2022.05.010
  13. McNerney KO, Amy M, Winestone LE, Baggott C, Talano J, Schiff J, et al. Practice preferences for consolidative hematopoietic stem cell transplantation following Tisagenlecleucel in children and young adults with B cell acute lymphoblastic leukemia. Transplant Cell Ther. 2024;30:75.e1–75.e11. Available from: https://doi.org/10.1016/j.jtct.2023.10.004
  14. Kurosawa S, Fukuda T, Ichinohe T, Hashii Y, Kanda J, Goto H, et al. Center effect on allogeneic hematopoietic stem cell transplantation outcomes for B-cell acute lymphoblastic leukemia. Cytotherapy. 2024;26:1185–1192. Available from: https://doi.org/10.1016/j.jcyt.2024.05.004
  15. Charafeddine KM, Hatoum HA, Otrock ZK, Mahfouz RA, Salem ZM, Shamseddine AI, et al. Long-term outcome of adult acute lymphoblastic leukemia in Lebanon: A single institution experience from the American University of Beirut. Hematol Oncol Stem Cell Ther. 2009;2:333–339. Available from: https://doi.org/10.1016/s1658-3876(09)50021-0
  16. Alghamdi AT, Alead JE, Darwish EG, Matasif ST, Qari MH. Prognostics and clinical outcomes in patients diagnosed with acute lymphoblastic leukemia in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Cureus. 2022;14:e22952. Available from: https://doi.org/10.7759/cureus.22952
  17. Abboud MR, Ghanem K, Muwakkit AS. Acute lymphoblastic leukemia in low and middle-income countries: Disease characteristics and treatment results. Curr Opin Oncol. 2014;26:650–655. Available from: https://doi.org/10.1097/cco.0000000000000125
  18. El-Cheikh J, El Dika I, Massoud R, Charafeddine M, Mahfouz R, Kharfan-Dabaja MA, et al. Hyper-CVAD compared with BFM-like chemotherapy for the treatment of adult acute lymphoblastic leukemia: A retrospective single-center analysis. Clin Lymphoma Myeloma Leuk. 2017;17:179–185. Available from: https://doi.org/10.1016/j.clml.2016.11.002
  19. Al-Sweedan S, Al-Seraihy A, Al-Ahmari A, Al-Jefri A, Mohammed V, Jafri R, et al. Factors determining the outcome of hematopoietic stem cell transplantation in patients with acute lymphoblastic leukemia at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. J Pediatr Hematol Oncol. 2017;39:33–37. Available from: https://doi.org/10.1097/mph.0000000000000679
  20. Silva WF, Cysne DN, Kerbauy MN, Colturato I, Maia ACA, Tucunduva L, et al. Predictive factors and outcomes after allogeneic stem cell transplantation for adults with acute lymphoblastic leukemia in Brazil. Transplant Cell Ther. 2022 Nov;28:763.e1–763.e7. Available from: https://doi.org/10.1016/j.jtct.2022.07.025
  21. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th Edition). Lyon: IARC; 2017. Available from: https://publications.iarc.fr/Book-And-Report-Series/Who-Classification-Of-Tumours/WHO-Classification-Of-Tumours-Of-Haematopoietic-And-Lymphoid-Tissues-2017
  22. Heuser M, Freeman SD, Ossenkoppele GJ, Buccisano F, Christopher S, Hourigan CS, et al. Update on MRD in acute myeloid leukemia: a consensus document from the European LeukemiaNet MRD Working Party. Blood. 2021;138:2753–2767. Available from: https://doi.org/10.1182/blood.2021013626
  23. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus HM, Ho V, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant. 2009;15:1628–1633. Available from: https://doi.org/10.1016/j.bbmt.2009.07.004
  24. Carreras E, Dufour C, Mohty M, Kröger N. The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies [Internet]. 7th ed. Springer; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553978/ [Accessed: 8 May 2023]
  25. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15:825–828. Available from: https://pubmed.ncbi.nlm.nih.gov/7581076/
  26. Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015;21:389–401. Available from: https://doi.org/10.1016/j.bbmt.2014.12.001
  27. Scrucca L, Santucci A, Aversa F. Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transplant. 2007;40:381–387. Available from: https://doi.org/10.1038/sj.bmt.1705727
  28. Iacobelli S. Suggestions on the use of statistical methodologies in studies of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2013;48(suppl 1):S1–S37. Available from: https://doi.org/10.1038/bmt.2012.282
  29. Goldstone AH, Richards SM, Lazarus HM, Tallman MS, Buck G, Fielding AK, et al. In adults with standard-risk acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in ALL patients: final results of the international ALL trial (MRC UKALL XII/ECOG E2993). Blood. 2008;111:1827–1833. Available from: https://doi.org/10.1182/blood-2007-10-116582
  30. Cornelissen JJ, van der Holt B, Verhoef GE, van't Veer MV, van Oers MH, Schouten HC, et al. Myeloablative allogeneic versus autologous stem cell transplantation in adult patients with acute lymphoblastic leukemia in first remission: a prospective sibling donor versus no-donor comparison. Blood. 2009;113:1375–1382. Available from: https://doi.org/10.1182/blood-2008-07-168625
  31. Ribera JM, Morgades M, Ciudad J, Montesinos P, Esteve J, Genesc EP, et al. Chemotherapy or allogeneic transplantation in high-risk Philadelphia chromosome-negative adult lymphoblastic leukemia. Blood. 2021;137:1879–1894. Available from: https://doi.org/10.1182/blood.2021013626

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

  • Synthesis of Carbon Nano Fiber from Organic Waste and Activation of its Surface Area
    Himanshu Narayan*, Brijesh Gaud, Amrita Singh and Sandesh Jaybhaye Himanshu Narayan*,Brijesh Gaud,Amrita Singh,Sandesh Jaybhaye. Synthesis of Carbon Nano Fiber from Organic Waste and Activation of its Surface Area. Int J Phys Res Appl. 2019: doi: 10.29328/journal.ijpra.1001017; 2: 056-059
  • Obesity Surgery in Spain
    Aniceto Baltasar* Aniceto Baltasar*. Obesity Surgery in Spain. New Insights Obes Gene Beyond. 2020: doi: 10.29328/journal.niogb.1001013; 4: 013-021
  • Tamsulosin and Dementia in old age: Is there any relationship?
    Irami Araújo-Filho*, Rebecca Renata Lapenda do Monte, Karina de Andrade Vidal Costa and Amália Cinthia Meneses Rêgo Irami Araújo-Filho*,Rebecca Renata Lapenda do Monte,Karina de Andrade Vidal Costa,Amália Cinthia Meneses Rêgo. Tamsulosin and Dementia in old age: Is there any relationship?. J Neurosci Neurol Disord. 2019: doi: 10.29328/journal.jnnd.1001025; 3: 145-147
  • Case Report: Intussusception in an Infant with Respiratory Syncytial Virus (RSV) Infection and Post-Operative Wound Dehiscence
    Lamin Makalo*, Orlianys Ruiz Perez, Benjamin Martin, Cherno S Jallow, Momodou Lamin Jobarteh, Alagie Baldeh, Abdul Malik Fye, Fatoumatta Jitteh and Isatou Bah Lamin Makalo*,Orlianys Ruiz Perez,Benjamin Martin,Cherno S Jallow,Momodou Lamin Jobarteh,Alagie Baldeh,Abdul Malik Fye,Fatoumatta Jitteh,Isatou Bah. Case Report: Intussusception in an Infant with Respiratory Syncytial Virus (RSV) Infection and Post-Operative Wound Dehiscence. J Community Med Health Solut. 2025: doi: 10.29328/journal.jcmhs.1001051; 6: 001-004
  • The prevalence and risk factors of chronic kidney disease among type 2 diabetes mellitus follow-up patients at Debre Berhan Referral Hospital, Central Ethiopia
    Getaneh Baye Mulu, Worku Misganew Kebede, Fetene Nigussie Tarekegn, Abayneh Shewangzaw Engida, Migbaru Endawoke Tiruye, Mulat Mossie Menalu, Yalew Mossie, Wubshet Teshome and Bantalem Tilaye Atinafu* Getaneh Baye Mulu,Worku Misganew Kebede,Fetene Nigussie Tarekegn,Abayneh Shewangzaw Engida,Migbaru Endawoke Tiruye,Mulat Mossie Menalu,Yalew Mossie,Wubshet Teshome,Bantalem Tilaye Atinafu*. The prevalence and risk factors of chronic kidney disease among type 2 diabetes mellitus follow-up patients at Debre Berhan Referral Hospital, Central Ethiopia. J Clini Nephrol. 2023: doi: 10.29328/journal.jcn.1001104; 7: 025-031

Read More

Most Viewed

Read More

Help ?