Allogeneic Stem Cell Transplantation in First Complete Remission for Patients With Philadelphia Chromosome-Positive ALL

Patients with Philadelphia chromosome-positive (Ph-positive) acute lymphoblastic leukemia (ALL) who achieved complete molecular remission within 3 months and received allogeneic stem cell transplantation (ASCT) in the first complete remission (CR1) demonstrated superior survival outcomes and lower relapse when compared with patients who did not undergo ASCT, according to findings from a study published in the American Journal of Hematology.

This study included 147 patients with Ph-positive ALL who achieved complete molecular remission (CMR) within 3 months. These patients were gathered from prospective clinical studies in the tyrosine kinase inhibitor era assessed by the Japan Adult Leukemia Study Group. Among these patients, 101 underwent ASCT and 46 did not undergo ASCT. 

According to a multivariate analysis, ASCT was significantly correlated with superior overall survival (adjusted hazard ratio [aHR]: 0.54; 95% confidence interval [CI], 0.30 to 0.97; p = .04). ASCT was also associated with relapse-free survival (aHR: 0.21; 95% CI; p < .001). Among patients who received ASCT, the 5-year adjusted overall survival was 73% and the 5-year adjusted relapse-free survival was 70%. Among patients who did not receive ASCT, the 5-year adjusted overall survival was 50%, and the 5-year adjusted relapse-free survival was 20%. 

The study authors noted that although there was a higher non-relapse mortality (aHR: 3.49; 95% CI, 1.17 to 10.4; p = .03), patients who received ASCT had a significantly lower relapse rate (aHR: 0.10; 95% CI, 0.05 to 0.20; p < .001). ASCT was also associated with superior graft-versus-host disease-free, relapse-free survival. According to propensity score-matched analyses, the results of the multivariate analyses have been confirmed. 

Based on these findings, Satoshi Nishiwaki, MD, Nagoya University Hospital, Nagoya, Japan, and coauthors concluded, “In patients who achieved CMR within 3 months, [ASCT] in CR1 had superior survival and lower relapse compared with the non-SCT cohort.”

Source: 

Nishiwaki S, Sugiura I, Fujisawa S, et al. Utility of allogeneic stem cell transplantation for adult Ph+ALL with complete molecular remission. Am J of Hematol. Published online: February 5, 2024. doi: 10.1002/ajh.27237