Research progress of tyrosine kinase inhibitor combining with allogeneic hematopoietic stem cell transplantation in treatment of Philadelphia chromosome positive acute lymphoblastic leukemia

Abstract

Philadelphia chromosome positive (Ph+ ) acute lymphoblastic leukemia (ALL) is the most common type of adult acute lymphoblastic leukemia(ALL). Before the advent of tyrosine kinase inhibitors(TKI), Ph+ ALL carried a dismal prognosis.Outcomes for patients with Ph+ ALL improved substantially with the administration of TKI, and the TKI induced complete remissions(CR) in more than 90% patients, with remission duration prolonging , making more patients able to undergo allogeneic hematopoietic stem cell transplantation(allo-HSCT). Currently, TKI-based chemotherapy following allo-HSCT is established as the first-line strategy. Breakpoint cluster region-abelson leukemia virus(BCR-ABL) monitoring appears to relate to prognostic relevance and may be as guiding treatment before allo-HSCT, but clinical benefit is controversial in the TKI era.Alternative donor transplantation obtains promising effect in clinical practice, but needs more research.The administration of TKI after allo-HSCT may improve quality of life and prolong life span, but relapse remains a major problem of treatment failure, what is the best strategy for giving TKI and how to treat relapse after allo-HSCT requires the larger samples and multi-centre randomized controlled trials. Key words: Leukemia, lymphoblastic, acute; Philadelphia chromosome; Hematopoietic stem cell transplantation; Tyrosine kinase inhibitors