Purpose
The introduction of tyrosine kinase inhibitors (TKI) has revolutionized therapy for patients with acute lymphoblastic leukemia (ALL) who have the Philadelphia (Ph) chromosome.
Patients and methods
A retrospective analysis was conducted on 102 adults and 11 children who received a first matched related (n =60), matched unrelated (n =40), mismatched cord blood (n=12), or haplo-identical (n=1) allogeneic hematopoietic stem cell transplant (HSCT) for Ph+ ALL in first complete remission (n=71), second complete remission (n=11) or with active disease (n=31) between 1990 and 2009. Sixtyseven patients received TKI with upfront ALL therapy, and 32 patients received TKI maintenance following HSCT.
Results
With median follow-up of 5 years among survivors (range, 1.1–20.4 years), overall survival (OS) was significantly better for patients transplanted in first remission compared with HSCT in advanced disease: 43% vs. 16%, p=0.002. Disease stage and age at time of HSCT, the development of acute GVHD, and decade of HSCT were found to significantly impact OS, progression-free survival (PFS) and non-relapse mortality (NRM) in multivariate analyses.
Conclusion
Allogeneic HSCT provides durable remission for patients with Ph+ ALL in first remission. Neither TKI use pre- nor post HSCT were found to significantly impact transplant outcomes in univariate and multivariate analyses.