Comparative Analysis of Treatment Outcomes and Prognostic Factors in Early T-Precursor Versus Non-ETP Acute Lymphoblastic Leukemia Following Allogeneic Hematopoietic Stem Cell Transplantation in Adolescents and Young Adults.

Abstract

This study evaluates the outcomes and risk factors associated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adolescents and young adults (AYA) diagnosed with early T-precursor (ETP) acute lymphoblastic leukemia (ALL) compared to non-ETP ALL.We retrospectively analyzed 178 AYA patients with T-ALL who were treated between September 2014 and December 2022. Out of 178 patients, 128 underwent allo-HSCT, with a median age of 25 years (range: 18-35). Among them, 49 were in the ETP group and 79 in the non-ETP group. Neutrophil and platelet engraftment times were comparable between groups. 3-year OS rates were 67.3% for ETP and 65.8% for non-ETP patients; 3-year LFS rates were 65.3% and 65.8%, respectively, showing no significant difference. Cumulative incidence of relapse (22.1% vs. 21.6%) and non-relapse mortality rates (17.8% vs. 13.7%) were similar. The incidence of acute and chronic GVHD, along with infections, showed no significant differences. Multivariable analysis revealed first complete remission before transplantation as a positive predictor for OS and LFS in non-ETP patients. In ETP patients, a white blood cell count below 30 × 10⁹/L predicted better LFS outcomes. A hemoglobin level below 120 g/L was independently associated with improved OS in non-ETP patients. Allo-HSCT offers effective improvement in prognosis for ETP-ALL, with survival outcomes comparable to non-ETP ALL patients.