The role of allogeneic transplant for adult Ph(+) ALL in CR1 with complete molecular remission: A retrospective analysis Journal Article
| Authors: | Ghobadi, A.; Slade, M.; Kantarjian, H.; Alvarenga, J.; Aldoss, I.; Mohammed, K. A.; Jabbour, E.; Faramand, R.; Shah, B. J.; Locke, F.; Fingrut, W.; Park, J. H.; Short, N. J.; Gao, F.; Uy, G. L.; Westervelt, P.; DiPersio, J. F.; Champlin, R. E.; Al Malki, M. M.; Ravandi, F.; Kebriaei, P. |
| Article Title: | The role of allogeneic transplant for adult Ph(+) ALL in CR1 with complete molecular remission: A retrospective analysis |
| Abstract: | Historically, Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) has been associated with poor outcomes, and allogeneic hematopoietic cell transplantation (allo-HCT) is recommended in first complete remission (CR1). However, in the tyrosine kinase inhibitor (TKI) era, rapid attainment of a complete molecular remission (CMR) is associated with excellent outcomes without allo-HCT, suggesting transplant may not be required for these patients. To test this hypothesis, we retrospectively identified adult patients with Ph+ ALL treated with induction therapy, including TKIs, and attained CMR within 90 days of diagnosis at 5 transplant centers in the United States. We compared outcomes of those who did and did not receive allo-HCT in first remission. We identified 230 patients (allo-HCT: 98; non-HCT: 132). The allo-HCT cohort was younger with better performance status. On multivariable analysis (MVA), allo-HCT was not associated with improved overall survival (adjusted hazard ratio [aHR]: 1.05; 95% CI, 0.63-1.73) or relapse-free survival (aHR: 0.86; 95% CI, 0.54-1.37) compared with non-HCT treatment. Allo-HCT was associated with a lower cumulative incidence of relapse (aHR: 0.32; 95% CI, 0.17-0.62) but higher non-relapse mortality (aHR: 2.59; 95% CI, 1.37-4.89). Propensity score matching analysis confirmed results of MVA. Comparison of reduced-intensity HCT to non-HCT showed no statistically significant difference in any of the above endpoints. In conclusion, adult patients with Ph+ ALL who achieved CMR within 90 days of starting treatment did not derive a survival benefit from allo-HCT in CR1 in this retrospective study. |
| Keywords: | survival; imatinib; therapy; impact; stem-cell transplantation; term-follow-up; acute lymphoblastic-leukemia; reduced-intensity; hyper-cvad; chemotherapy plus dasatinib |
| Journal Title: | Blood |
| Volume: | 140 |
| Issue: | 20 |
| ISSN: | 0006-4971 |
| Publisher: | American Society of Hematology |
| Date Published: | 2022-11-17 |
| Start Page: | 2101 |
| End Page: | 2112 |
| Language: | English |
| ACCESSION: | WOS:000916621900006 |
| DOI: | 10.1182/blood.2022016194 |
| PROVIDER: | wos |
| PMCID: | PMC9837437 |
| PUBMED: | 35877996 |
| Notes: | Article -- Source: Wos |
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