title: Pre-transplant achievement of negativity in minimal residual disease and French-American-British L1 morphology predict superior outcome after allogeneic transplant for Philadelphia chromosome positive acute lymphoblastic leukemia: an analysis of Southeast Asian patients.
abstract: To better understand predictive factors and improve the clinical outcome of allogeneic transplant for patients with Philadelphia positive acute lymphoblastic leukemia, we analyzed 67 Southeast Asian patients transplanted in our institutions. Multivariate analysis showed that disease status before transplant, year of transplant and, interestingly, French-American-British (FAB) subtype had a significant impact on overall survival (OS) and non-relapse mortality. Patients who were minimal residual disease (MRD) negative at transplant had a 3-year OS of 73% compared to those who were MRD positive (45%) and refractory (0%). The 3-year cumulative incidence of relapse was 18% and 36% for the MRD negative and positive groups, respectively. FAB L1 subtype had a significantly superior 3-year OS of 63% vs. 29% for L2 subtype. Pre-transplant use of a tyrosine kinase inhibitor significantly improved outcomes in univariate but not multivariate analysis, as it served to induce more patients into MRD negativity, which was the factor that directly improved transplant outcome.
authors.affiliation: Division of Hematology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , People's Republic of China.
authors.forename: Liyuan
authors.initials: L
authors.lastname: Ma
authors.forename: Siguo
authors.initials: S
authors.lastname: Hao
authors.forename: Colin
authors.initials: C
authors.lastname: Diong
authors.forename: Yeow-Tee
authors.initials: YT
authors.lastname: Goh
authors.forename: Sathish
authors.initials: S
authors.lastname: Gopalakrishnan
authors.forename: Aloysius
authors.initials: A
authors.lastname: Ho
authors.forename: William
authors.initials: W
authors.lastname: Hwang
authors.forename: Liang-Piu
authors.initials: LP
authors.lastname: Koh
authors.forename: Mickey
authors.initials: M
authors.lastname: Koh
authors.forename: Zi-Yi
authors.initials: ZY
authors.lastname: Lim
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Loh
authors.forename: Michelle
authors.initials: M
authors.lastname: Poon
authors.forename: Lip-Kun
authors.initials: LK
authors.lastname: Tan
authors.forename: Patrick
authors.initials: P
authors.lastname: Tan
authors.forename: Yeh-Ching
authors.initials: YC
authors.lastname: Linn
mesh_terms: D000293:Adolescent; D000328:Adult; D001210:Asia, Southeastern; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D016879:Salvage Therapy; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Philadelphia chromosome positive acute lymphoblastic leukemia; allogeneic hematopoietic stem cell transplant; complete remission; minimal residual disease; tyrosine kinase inhibitor