title: Long-term follow-up of allogeneic hematopoietic stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia: impact of tyrosine kinase inhibitors on treatment outcomes.
abstract: The introduction of tyrosine kinase inhibitors (TKI) has revolutionized therapy for patients with acute lymphoblastic leukemia (ALL) who have the Philadelphia (Ph) chromosome. 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 haploidentical (n = 1) allogeneic hematopoietic stem cell transplantation (HSCT) for Ph-positive (Ph+) ALL in first complete remission (n = 71), second complete remission (n = 11), or with active disease (n = 31) between 1990 and 2009. Sixty-seven patients received TKI with upfront ALL therapy, and 32 patients received TKI maintenance following HSCT. 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% versus 16%, P = .002. Disease stage and age at time of HSCT, the development of acute graft-versus-host disease (aGVHD), and decade of HSCT were found to significantly impact OS, progression-free survival (PFS), and nonrelapse mortality (NRM) in multivariate analyses. 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.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. pkebriaei@mdanderson.org
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.forename: Rima
authors.initials: R
authors.lastname: Saliba
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Alexandre
authors.initials: A
authors.lastname: Chiattone
authors.forename: Rajyalakshmi
authors.initials: R
authors.lastname: Luthra
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Borje
authors.initials: B
authors.lastname: Andersson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shpall
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Roy
authors.initials: R
authors.lastname: Jones
authors.forename: Laura
authors.initials: L
authors.lastname: Worth
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
authors.forename: Deborah
authors.initials: D
authors.lastname: Thomas
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006648:Histocompatibility / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases