ALL-051: Outcomes of Treatment of Acute Philadelphia-Positive Acute Lymphoblastic Leukemia with Autologous Transplant of Hematopoietic Stem Cells at San Juan De Dios Hospital from 2014 to 2019

Abstract

<h3>Context:</h3> Acute lymphoblastic leukemia with Philadelphia chromosome mutation is a disease with a guarded prognosis. Allogenic hematopoietic stem cell transplantation is a therapeutic alternative that offers a possibility of cure; however, its availability is limited by the availability of HLA-identical donors. Autologous stem cell transplantation and maintenance therapy with tyrosine kinase inhibitors is a therapy that has been proposed as an alternative and is frequently used in our setting for the treatment of consolidation. Given that many of the patients with a diagnosis of Philadelphia-positive ALL do not have an identical donor or are not robust enough to tolerate a haploidentical transplant, it is worth exploring the option of autologous transplantation associated with the use of tyrosine kinase inhibitors as a therapeutic possibility for these patients. <h3>Setting:</h3> Hematopoietic Stem Cell Transplant Unit, Hospital San Juan de Dios, Caja Costarricense de Seguro Social. <h3>Methods:</h3> Patients who were diagnosed between January 2014 and December 2019 with acute lymphoblastic leukemia and were documented to have the Philadelphia chromosome mutation were included. Epidemiological, clinical, and minimal residual disease data were documented, and the number of months that patients remained in remission following autologous stem cell transplantation as consolidation therapy at Hospital San Juan de Dios was sought. <h3>Results:</h3> Seven patients with ALL with identified Philadelphia chromosome mutation and autologous hematopoietic stem cell transplantation were evaluated, with a mean age at diagnosis of 41.6 (SD: 15.5) years and a sex distribution of 57.0% (4/7) female. The determination of relapse and death showed that 6 cases (86.0%) presented relapse to the bone marrow and 2 cases (29.0%) to the central nervous system. Death was documented in 5 of the patients evaluated (71.0%), all of which were due to sepsis. Analysis of progression-free survival evidenced a median of 17 months. <h3>Conclusions:</h3> Autologous stem cell transplant is associated with a low transplant-related mortality at our institution. However, the high relapse rate makes it unacceptable as a first-line consolidation therapy in Ph+ ALL patients with an allogenic donor option. No grant or external funding was received for this study.