title: Adult Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Daily Practice: A Multicenter Experience.
abstract: BACKGROUND
  The prognosis of Philadelphia-positive acute lymphoblastic leukemia (Ph(+) ALL) is generally poor. Currently, allogeneic hematopoietic cell transplantation (allo-HCT) is the only accepted therapy with curative potential.
  
  
  METHODS
  Herein, we report our multicenter, retrospective experience with 46 (23 female; 23 male) Ph(+) ALL patients, who were treated off-study between 2005 and 2012.
  
  
  RESULTS
  The median age of the patients was 46 years (range, 19-73 years). During induction, 30 (65%), 13 (28%), and 3 (7%) patients received tyrosine kinase inhibitors (TKIs) concurrent with chemotherapy (TKIs/chemotherapy), chemotherapy only, and TKIs only, respectively. Following induction, rates of complete remission (CR) of the study population were 85% (n = 39). CR rate in patients receiving TKIs during induction (n = 33) was significantly higher compared with patients who received chemotherapy only (n = 13; P = .011). Taking TKIs during induction significantly reduced induction mortality (3.3% vs. 38%; P = .01). Allo-HCT was performed subsequently in 21 (46%) patients. More patients who received TKIs with or without chemotherapy (19/33; 58%) during induction were able to undergo to allo-HCT compared with patients who received chemotherapy only (2/13; 15%; P = .005). Median overall survival of patients who were treated with TKIs during induction and received allo-HCT (not reached; NR) was significantly prolonged compared with patients who received allo-HCT but without TKIs during induction (23.2 months) and to the rest of the cohort (21.2 months; P = .019).
  
  
  CONCLUSIONS
  Current state-of-the art management of Ph(+) ALL in real-life seems to be incorporation of TKIs to chemotherapy regimens and proceeding to allo-HCT, whenever possible.
authors.affiliation: Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey. Electronic address: emretekgunduz@yahoo.com.
authors.forename: Emre
authors.initials: E
authors.lastname: Tekgündüz
authors.affiliation: Department of Internal Medicine, Division of Hematology, Hacettepe University Medical School, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Göker
authors.affiliation: Department of Internal Medicine, Division of Hematology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Leylagül
authors.initials: L
authors.lastname: Kaynar
authors.affiliation: Department of Internal Medicine, Division of Hematology, Pamukkale University Medical School, Denizli, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Sarı
authors.affiliation: Department of Internal Medicine, Division of Hematology, Erciyes University Medical School, Kayseri, Turkey.
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Pala
authors.affiliation: Department of Internal Medicine, Division of Hematology, Pamukkale University Medical School, Denizli, Turkey.
authors.forename: Mehmet Hilmi
authors.initials: MH
authors.lastname: Doğu
authors.affiliation: Department of Internal Medicine, Division of Hematology, Koç University Medical School, Istanbul, Turkey.
authors.forename: Erman
authors.initials: E
authors.lastname: Öztürk
authors.affiliation: Department of Internal Medicine, Division of Hematology, Namık Kemal University Medical School, Tekirdağ, Turkey.
authors.forename: Burhan
authors.initials: B
authors.lastname: Turgut
authors.affiliation: Department of Internal Medicine, Division of Hematology, Cumhuriyet University Medical School, Sivas, Turkey.
authors.forename: Serdal
authors.initials: S
authors.lastname: Korkmaz
authors.affiliation: Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Tetik
authors.affiliation: Department of Internal Medicine, Division of Hematology, Hacettepe University Medical School, Ankara, Turkey.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Büyükaşık
authors.affiliation: Department of Internal Medicine, Division of Hematology, Pamukkale University Medical School, Denizli, Turkey.
authors.forename: Sibel Kabukçu
authors.initials: SK
authors.lastname: Hacıoğlu
authors.affiliation: Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Sinem Civriz
authors.initials: SC
authors.lastname: Bozdağ
authors.affiliation: Department of Internal Medicine, Division of Oncology, Hacettepe University Medical School, Ankara, Turkey.
authors.forename: Evren
authors.initials: E
authors.lastname: Özdemir
authors.affiliation: Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Altuntaş
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D047428:Protein Kinase Inhibitors
keywords: Acute lymphoblastic leukemia; Allogeneic transplantation; BCR-ABL; Philadelphia chromosome; Stem cell transplantation