Prognostic analysis of allogeneic hematopoietic stem cell transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia in complete remission in the era of tyrosine kinase inhibitors
10.3760/cma.j.issn.0253-2727.2020.07.006
- VernacularTitle:酪氨酸激酶抑制剂时代完全缓解状态下Ph染色体阳性急性淋巴细胞白血病异基因造血干细胞移植预后分析
- Author:
Xingyu CAO
1
;
Wei MA
;
Wei ZHANG
;
Deyan LIU
;
Yanli ZHAO
;
Yue LU
;
Jianping ZHANG
;
Jiarui ZHOU
;
Min XIONG
;
Zhijie WEI
;
Ruijuan SUN
Author Information
1. 河北燕达陆道培医院造血干细胞移植科，廊坊 065201
- Keywords:
Leukemia, lymphoblastic, acute;
Philadelphia chromosome;
Allogeneic hematopoietic stem cell transplantation;
Complete remission;
Tyrosine kinase inhibitor
- From:
Chinese Journal of Hematology
2020;41(7):564-569
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the clinical results and prognostic factors for allo-HSCT of Philadelphia chromosome-positive (Ph +) acute lymphoblastic leukemia (ALL) in complete remission (CR) in the era of tyrosine kinase inhibitors (TKI) . Methods:We performed a retrospective analysis of the clinical characteristics of 116 patients with Ph +ALL who underwent allo-HSCT while in CR. Results:The study population included 72 men and 44 women. The median patient age was 20 years (4-64 years) . The patients received sibling-identical donor ( n=21) , haplo ( n=77) , and unrelated donor ( n=18) HSCT. The overall survival (OS) rate at 5 years was 73.2% (95% CI 63.8% -80.5% ) . In particular, the 5-year OS can reach 87.5% when the time from diagnosis to transplant is <180 days. The 5-years DFS was 61.4% (95% CI 51.8% -69.7% ) , the 5-year molecular and morphology cumulative relapse incidence was 18.5% (95% CI 12.6% -27.3% ) , and the 5-year TRM was 19.9% (95% CI 13.8% -28.7% ) . A multivariate analysis showed that an age range of 15-39 years ( HR=2.730, P=0.044) , time from diagnosis to HSCT ≥ 180 days ( HR=4.534, P=0.010) , and Ⅲ-Ⅳgrade aGVHD ( HR=7.558, P=0.000) were significantly associated with an inferior overall survival. Limited cGVHD subgroup had better OS ( HR=0.300, P=0.034) . Sex, WBC count at diagnosis, type of BCR-ABL fusion genes, somatic gene mutations, CR 1 or >CR 1, MRD negative or positive, conditioning regimen based on TBI or Bu, conditioning intensity, donor source, GVHD prophylactic proposal using cyclosporine or tacrolimus, presence/absence of CMV viremia, and presence/absence of EBV viremia were not significantly different in terms of the OS and DFS. Conclusion:Factors influencing the overall survival of Ph + ALL patients who underwent allo-HSCT in CR in the TKI era include age, time form diagnosis to HSCT, and aGVHD severity.
