Comparison allogeneic hematopoietic stem cell transplantation and chemotherapy for consolidation in acute lymphoblastic leukemia in a Colombian Cohort. A propensity score matching analysis.
Abstract
Background
The role of allogeneic hematopoietic stem cells transplantation (allo-HSCT) as a consolidation strategy for adult acute lymphoblastic leukemia (ALL) in the first complete remission remains a subject of significant clinical debate. We sought to evaluate the comparative efficacy of allo-HSCT versus chemotherapy-based consolidation in a demographic with high prevalence of adverse genetic markers.
Methods
We conducted a multicenter retrospective cohort study of adult patients (Aged 18-60 years) with ALL in first complete remission diagnosed between 2009 and 2024. Propensity score matching (PSM) was utilized to balance baseline covariates between treatment groups. Primary endpoints included 60-month overall survival (OS) and leukemia-free survival (LFS).
Results
The final matched cohort included 149 patients in the allo-HSCT group and 149 in the chemotherapy group. The 60-month OS was significantly superior in the allo-HSCT group at 62.7% (95% CI:54-71.6%)compared to 32%(95%CI; 24.9-40.9%) in the chemotherapy group HR 0.42; 95% CI: 0.30-0.58; p < 0.001. Similarly, the 60-month LFS was 59.7% (95% CI:59.7-68.6%) for the transplant cohort versus 23.1% (95% CI:16.8-31.7%) for the chemotherapy cohort. HR 0.35; 95% CI: 0.25-0.48; p < 0.001). While transplant was associated with a lower cumulative incidence of relapse, the 60-month non-relapse mortality was significantly higher in the allo-HSCT group (17.2% vs 7.2%; p = 0.015).
Interpretation
In adult ALL patients in first remission, consolidation with allo-HSCT provides a substantial survival benefit and superior disease control compared to chemotherapy. Despite the increased risk of non-relapse mortality, these findings suggest that transplantation should be considered a preferred consolidation strategy, particularly in populations where high-risk genetic profiles are prevalent.