Relaps/Refrakter Akut Lenfoblastik Lösemide İnotuzumab Ozogamisin Tedavisi Sonrası Allojenik Kök Hücre Nakli Sonuçları

Objective: The prognosis of relapsed/refractory ALL (R/R ALL) in adults is dismal. Allogeneic hematopoietic stem cell transplantation (ASCT) is the only available curative treatment option in R/R ALL. The primary aim of salvage treatments is to provide the deepest disease control, while creating a safe bridge to ASCT. Monotherapy with Inotuzumab ozogamycin (InO) has been reported to provide deep treatment responses at a high rate, as well as enabling for ASCT four times higher than standard chemotherapies. This study summarizes the outcomes of R/R ALL patients who underwent ASCT in our center after receiving InO salvage therapy. Patients and Methods: R/R ALL patients who underwent ASCT in our center between January 2018 and January 2021 after achieving remission with InO salvage were retrospectively evaluated. Results: A total of six patients, three of whom were male, with a median age of 40 (19-71) at the time of ASCT were included. Two patients received InO treatment before the second or third ASCT, while the remaining four before the first. A median of two courses (1-4) of InO was administered. No serious adverse events were observed during treatment with InO. Venoocclusive disease prophylaxis with defibrotide was given to 83.3% (n= 5) of the patients during ASCT. Transplant-related mortality was observed in 50% (n= 3), and mortality due to early disease progression (central nervous system involvement) was observed in 16.7% (n= 1) of patients. Overall survival tended to be lower in patients receiving more than two courses of InO (p= 0.10, by log-rank test). Of the patients 33.3% (n= 2) are in complete remission (CR) within a median follow-up of 28 months (8-47) without any transplant-related complications. Conclusion: Long-term survival is possible in R/R ALL with ASCT after obtaining CR via InO salvage. More than two cycles of InO before ASCT should be avoided as it increases transplant-related early mortality. Venooclusive disease, reported as the most important cause of early mortality, was not observed in this study.