As reported in the Journal of Clinical Oncology by Knörr et al, a trial of risk-stratified treatment for relapsed pediatric anaplastic large cell lymphoma (ALCL) showed that allogeneic stem cell transplantation (SCT) was effective in patients with high-risk relapse, whereas autologous SCT was not effective in individuals with early relapse.
Study Details
The ALCL-Relapse trial enrolled patients from sites in the United Kingdom, Germany, Austria, Switzerland, and the Czech Republic. The study stratified children and adolescents with relapsed ALCL according to the time of relapse, CD3 expression, and prior vinblastine therapy to three different consolidation approaches:
- Patients with progression during front-line therapy (very high–risk) or a CD3-positive relapse (high-risk) were scheduled for allogeneic SCT after reinduction chemotherapy.
- Patients with a CD3-negative relapse within 1 year after initial diagnosis or prior exposure to vinblastine (intermediate-risk) received autologous SCT after treatment with carmustine/etoposide/cytarabine/melphalan; this arm was terminated prematurely in a protocol amendment, with subsequently enrolled patients receiving vinblastine monotherapy.
- Patients with a CD3-negative relapse > 1 year after initial diagnosis (low-risk) received vinblastine monotherapy.
Treatment Outcomes
Among all 105 evaluable patients, 17 were very high risk, 26 were high risk, 32 were intermediate risk (with 5 additional intermediate-risk patients added after the protocol amendment), 21 were low risk, and 4 had no assigned risk group.
Among all patients, 5-year event-free survival was 53% and 5-year overall survival was 78%. Prior to termination of the autologous SCT arm, 5-year event-free survival was 41% in the very high–risk group, 62% in the high-risk group, 44% in the intermediate-risk group, and 81% in the low-risk group.
Five-year overall survival was 59% in the very high–risk group, 73% in the high-risk group, 78% in the intermediate-risk group, and 90% in the low-risk group.
Among the 23 patients in the intermediate-risk group scheduled for the protocol-intended consolidation by autologous SCT, 5-year event-free and overall survival rates were 30% and 78%. All five intermediate-risk patients receiving vinblastine monotherapy after the amendment experienced relapse.
Overall, 36 patients received allogeneic SCT as first SCT for consolidation after first relapse (including 8 very high–risk, 17 high-risk, and 8 intermediate-risk, and 1 low-risk patient, and 2 with no risk stratification). Among these patients, 5-year event-free and overall survival were 81% and 83%.
Overall, 22 patients received autologous SCT as first SCT for first relapse (including 3 high-risk, 16 intermediate-risk, and 1 low-risk patient, and 2 with no risk stratification). Among these patients, 5-year event-free and overall survival were 41% and 82%.
The investigators concluded, “Shorter time to relapse was the strongest predictor of subsequent relapse. Allogeneic SCT offers a chance for cure in patients with high-risk ALCL relapse. For early relapsed ALCL, autologous SCT was not effective. Vinblastine monotherapy achieved cure in patients with late relapse; however, it was not effective for early relapses.”
Wilhelm Woessmann, MD, of the University Medical Center Hamburg-Eppendorf, Hamburg, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Forschungshilfe Peiper. For full disclosures of the study authors, visit ascopubs.org.
