Therapeutic effect and prognostic factors of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

Abstract

Objective To explore the outcome and prognostic factors of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). Methods Forty-nine newly diagnosed adult patients with Ph+ ALL were analyzed retrospectively, and the treatment effect and the impact of different factors on prognosis were explored. Results In 49 patients, there were 24 males and 25 females; the median age was 38 years (range 15-77 years). Hematologic complete remission (CR), major molecular response (MMR) and complete molecular remission (CMR) rate in patients received tyrosine kinase inhibitors (TKI) plus chemotherapy were higher than those in patients received chemotherapy only (96.8% vs. 72.2%, χ2 = 4.308, P = 0.038; 64.5% vs. 16.7%, χ 2 = 10.468, P = 0.001; 25.8% vs. 11.1%, χ 2 = 4.250, P = 0.039). With a median overall survival (OS) of 24 months (3-70 months), the 3-year OS and relapse-free survival (RFS) rates were 32.7% and 21.4%, respectively. The 3-year OS rate and 1-year RFS rate in TKI plus chemotherapy group were 40.3% and 67.8% respectively, which were higher than those in chemotherapy group (11.1% and 11.1%) (χ 2 = 12.725, χ 2 = 17.401, both P < 0.001). The 3-year OS and RFS rates in the allogeneic hematopoietic stem cell transplantation (allo-HSCT) group were higher than those in the group without allo-HSCT (62.5% vs. 25.7%, χ2 = 6.196, P = 0.013; 41.7% vs. 15.0%, χ2 = 8.032, P = 0.005). The 3-year OS and RFS rates in patients achieved MMR after 2 circles treatment were higher than those in the others (45.1% vs. 17.6%, χ2 = 5.446, P = 0.020; 28.9% vs. 11.7%, χ2 = 6.484, P = 0.011). Multivariate analysis showed that received TKI (HR = 0.227, 95% CI 0.094-0.550, P = 0.001) was an independent prognostic factor for OS; received TKI (HR = 0.225, 95% CI 0.082-0.618, P = 0.004) and allo-HSCT (HR = 0.275, 95% CI 0.077-0.983, P = 0.047) were independent prognostic factors for RFS. Conclusions TKI can increase CR, MMR and CMR rates, improve outcome, and give more chance to receive HSCT. In TKI era, allo-HSCT is still the important treatment for Ph+ ALL, especially for patients without MMR. Key words: Leukemia, acute; Philadelphia chromosome; Prognosis; Hematopoietic stem cell transplantation; Imatinib