Abstract
We investigated prognostic factors for the clinical outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) following imatinib-based therapy. Among 100 adult patients who were prospectively enrolled in the JALSG Ph+ALL202 study, 97 patients obtained complete remission (CR) by imatinib-combined chemotherapy, among whom 60 underwent allo-HSCT in their first CR. The probabilities of overall survival (OS) and disease-free survival (DFS) at 3 years after HSCT were 64% (95% CI, 49–76) and 58% (95% CI, 43–70), respectively. Prognostic factor analysis revealed that the major BCR–ABL transcript was the only unfavorable predictor for OS and DFS after HSCT by both univariate (HR, 3.67 (95% CI 1.49–9.08); P=0.005 and HR, 6.25 (95% CI, 1.88–20.8); P=0.003, respectively) and multivariate analyses (HR, 3.20 (95% CI, 1.21–8.50); P=0.019 and HR, 6.92 (95% CI, 2.09–22.9); P=0.002, respectively). Minimal residual disease status at the time of HSCT had a significant influence on relapse rate (P=0.015). Further study of the BCR–ABL subtype for the clinical impact on outcome of allo-HSCT in Ph+ALL is warranted.
Highlights
20 to 25% of adult patients with acute lymphoblastic leukemia (ALL) harbor BCR–ABL fusion gene
We evaluated prognostic factors influencing overall survival (OS), disease-free survival (DFS), relapse and non-relapse mortality (NRM) after allo-hematopoietic stem cell transplantation (HSCT) among patients with Ph þ ALL who underwent HSCT in the imatinib era, by using the prospectively conducted data of Japan Adult Leukemia Study Group (JALSG) Ph þ ALL202 study
During the pre-imatinib era, several groups reported the relationship between the clinical outcome and BCR–ABL subtypes in patients with Ph þ ALL
Summary
20 to 25% of adult patients with acute lymphoblastic leukemia (ALL) harbor BCR–ABL fusion gene. The treatment success after allo-HSCT is impaired by the occurrence of post-transplant relapse and non-relapse mortality (NRM),[9,10,11] and identification of the risk factors causing relapse and NRM after allo-HSCT would be beneficial
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