Autologous Hematopoietic Stem Cell Transplantation May Overcome the Adverse Impact of IKZF1 on the Prognosis of B-ALL in CR1 with No Detectable Minimal Residual Disease

Abstract

Purpose: Ikaros family zinc finger 1 (IKZF1) mutation may serve as a poor prognostic factor in B-cell acute lymphoblastic leukemia (B-ALL). This study explored the impact of autologous hematopoietic stem cell transplantation (auto-HSCT) on the outcome of B-ALL patients with IKZF1 alterations. Methods: we detected the IKZF1 mutation at diagnosis in the bone marrow of adult patients with B-ALL, and analyzed the clinical data of these patients retrospectively. Results: A total of 38 B-ALL patients in CR1 were enrolled in the study, including 8 recipients of auto-HSCT and 30 of allo-HSCT. The treatment efficacy was evaluated from a model stratified on the risk classification and minimal residue disease (MRD) status after three chemotherapy cycles. Auto-HSCT demonstrated comparable 3-year overall survival (OS) (75% vs. 89.4%, p = 0.893) and leukemia-free survival rates (80% vs. 75.3%, p = 0.471) compared to allo-HSCT for patients with negative MRD (Figure 1). There was also no significant difference on 3-year relapse rate between auto-HSCT and allo-HSCT groups (20% vs. 26%, p=0.394). Conclusion: Auto-HSCT may be an attractive treatment for B-ALL patients of IKZF1 mutation with negative MRD after three chemotherapy cycles. The adverse impact of IKZF1 on prognosis may be overcome by auto-HSCT.