Superior survival with pediatric-style chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in older adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: Analysis from CALGB 10403 and the CIBMTR

Pediatric-style post-remission chemotherapy produced superior overall survival compared to myeloablative allogeneic HCT in AYAs with Ph-negative ALL in CR1, with 5-year OS of 66% vs 47%.

Effect: improvement; HR 2.00 (HCT vs chemotherapy); CI: 95% CI 1.5–2.66

Pediatric-style chemotherapy produced superior disease-free survival compared to myeloablative allogeneic HCT in AYAs with Ph-negative ALL in CR1.

Effect: improvement; HR 1.62 (HCT vs chemotherapy); CI: 95% CI 1.25–2.12

Myeloablative allogeneic HCT was associated with dramatically higher non-relapse mortality compared to pediatric-style chemotherapy, with 5-year NRM of 29% vs 8%.

Effect: adverse; HR 5.41 (HCT vs chemotherapy); CI: 95% CI 3.23–9.06

Pediatric-style chemotherapy was associated with higher 5-year cumulative relapse incidence compared to allogeneic HCT, though the timing of relapse differed: relapse was initially more likely with HC

Effect: decline; 5-year relapse 34% vs 23%

Obesity was independently associated with inferior OS, inferior DFS, increased relapse, and increased NRM in AYAs with Ph-negative ALL, regardless of whether they received chemotherapy or HCT.

Effect: decline; HR 2.17 (obese vs non-obese, OS); CI: 95% CI 1.63–2.89