A prognostic score system in adult T‐cell acute lymphoblastic leukemia after hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 59; no. 4; pp. 496 - 504
• Main Authors: Xiao, Mengyu, Zhou, Jianying, Zhu, Xiaolu, He, Yun, Wang, Fengrong, Zhang, Yuanyuan, Mo, Xiaodong, Han, Wei, Wang, Jingzhi, Wang, Yu, Chen, Huan, Chen, Yuhong, Zhao, Xiangyu, Chang, Yingjun, Xu, Lanping, Liu, Kaiyan, Huang, Xiaojun, Zhang, Xiaohui
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2024; Nature Publishing Group
• Subjects: 38/23; 38/77; 38/91; 692/699/1541/1990/283/2125; 692/700/1750; Acute lymphoblastic leukemia; Adult; Cell Biology; Central nervous system; Derivation; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Induction therapy; Internal Medicine; Leukemia; Lymphocytes T; Medicine; Medicine & Public Health; Minimal residual disease; Neoplasm, Residual - therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prognosis; Public Health; Retrospective Studies; Risk; Risk groups; Stem cell transplantation; Stem Cells; T-Lymphocytes; Transplantation
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-024-02211-8

Adult T-cell acute lymphoblastic leukemia (T-ALL) is highly aggressive with poor prognoses, while hematopoietic stem cell transplantation (HSCT) is a curable option. However, no transplant-specific prognostic model for adult T-ALL is available. We identified 301 adult T-ALL patients who received HSCT at our hospital between 2010 and 2022. These patients were randomly assigned at a 7:3 ratio to a derivation group of 210 patients and a validation group of 91 patients. Next, we developed a prognostic risk score system for adult T-ALL with HSCT, which we named COMM, including 4 predictors ( c entral nervous system involvement, N o n-CR1 (CR2+ or NR) at HSCT, m inimal residual disease (MRD) ≥ 0.01% after first induction therapy, and M RD ≥ 0.01% before HSCT). Patients were categorized into three risk groups, low-risk (0), intermediate-risk (1–4), and high-risk (5–12), and their 3-year overall survival (OS) were 87.5% (95%CI, 78–93%), 65.7% (95%CI, 53–76%) and 20% (95%CI, 10–20%; P < 0.001), respectively. The area under the subject operating characteristic curve for 2-, 3- or 5-year OS in the derivation cohort and in the validation cohort were all greater than 0.75. Based on internal validation, COMM score system proved to be a reliable prognostic model that could discriminate and calibrate well. We expect that the first prognostic model in adults T-ALL after HSCT can provide a reference of prognostic consultation for patients and families, and also contribute to future research to develop risk adapted interventions for high-risk populations.