Blood: Ph+ALL patients do not benefit from allogeneic hematopoietic cell transplantation!

Patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) have a poor
prognosis.
Therefore, patients with Ph+ ALL are advised to undergo allogeneic hematopoietic cell transplantation (allo-HCT)
at the time of first complete response (CR1).
However, in the era of tyrosine kinase inhibitors (TKIs), rapid achievement of complete molecular response (CMR) is associated with a good prognosis without allogeneic HCT, suggesting that these patients may not require transplantation
.

To test this hypothesis, the researchers retrospectively analyzed adult Ph+ ALL patients receiving induction therapy (including TKIs) at 5 transplant centers in the United States who received CMR
within 90 days of diagnosis.
The researchers compared clinical outcomes
in patients who received and did not receive alloc-HCT at first remission.

Clinical prognosis of patients in the allo-HCT group and the non-HCT group

A total of 230 patients were included (allo-HCT: 98; non-HCT: 132-bit).

Patients in the allo-HCT group were younger and performed better
.
In multivariate analysis (MVA), alloc-HCT was associated with overall survival (adjusted hazard ratio [aHR]: 1.
05; 95% CI 0.
63-1.
73) and recurrence-free survival (aHR: 0.
86; 95% CI 0.
54 to 1.
37) Improvement was not relevant
.
alloc-HCT was associated with a lower cumulative recurrence rate (aHR: 0.
32; 95% CI 0.
17 to 0.
62), but non-recurrence mortality was higher in patients with alloc-HCT (aHR: 2.
59; 95% CI 1.
37-4.
89)
。 Propensity score matching analysis confirmed the results
of MVA.
There was no statistically significant difference
between low-intensity HCT and non-HCT at none of these endpoints.

Overall, the results of this retrospective study suggest that adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia who achieve a complete molecular response within 90 days of initiating treatment do not derive a survival benefit
from allo-HCT at first complete response.

Original source:

Armin Ghobadi, Michael Slade, Hagop Kantarjian, et al.
The role of allogeneic transplant for adult Ph+ ALL in CR1 with complete molecular remission: a retrospective analysis.
Blood (2022) 140 (20): 2101–2112.