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Chemotherapy vs. allogeneic transplantation as post molecular remission therapy in patients aged less than 60 years with Philadelphia-positive ALL

Bone Marrow Transplantation volume 55, pages 245–248 (2020)Cite this article

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The advent of tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 led to revolutionary changes in the outcome of Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) patients. The sequential treatment with TKIs, chemotherapy, and allogeneic hematopoietic stem cell transplantation (alloHSCT) yielded higher complete remission (CR) rates and better 5-year overall survival (OS) rates of 36–86% in previous studies [1,2,3]. However, alloHSCT is still associated with substantial non-relapse mortality (NRM). Monitoring minimal or measurable residual disease (MRD) has been increasingly used in patients with ALL, which can identify patients more likely to benefit from alloHSCT in first CR [4,5,6]. Several studies have proved that complete molecular remission (CMR), have been associated with improved outcomes, both pre- and post-transplantation [5,6,7,8]. Nevertheless, whether patients with complete molecular remission still need an alloHSCT procedure in first remission remains inconclusive.

Between January 2007 and December 2017, 158 Ph+ ALL patients were included in the retrospective study, which was approved by the Ethics Committee and the observation of Declaration of Helsinki conditions. Sixty-three patients treated prior to 2012 were induced with Hyper-CVAD regimen, and consolidated with the regimen combinated with high-dose MTX and Ara-C; whereas 95 patients treated after that time were induced with the combination regimen with VDP, and four regimens comprising high-dose MTX, intermediate-dose Ara-C, etoposide combined with Ara-C, and VDP alternated for 6 cycles as consolidation at one-month interval. (Supplemental Table S1) Imatinib was administrated at a dose of 600 mg daily within 7 days from the diagnosis. 90 of 158 patients (56.9%) could not tolerate the full planned dose. Of them, 18 patients (11.4%) were switched to dasatinib, and the remaining 72 patients were administrated with imatinib at a minimum 400 mg daily within the first two months from the diagnosis.

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Acknowledgements

This work was supported by National Natural Science Foundation of China (NSFC; 81770160, 81470321, 81270567). XH was sponsored by Scholarship from Shanghai Municipal Health and Family Planning Commission (2017BR012).

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  1. These authors contributed equally: Libing Wang, Juan Du, Aijie Huang

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  1. Department of Hematology, Institute of Hematology, Changhai Hospital, 200433, Shanghai, China

    Libing Wang, Aijie Huang, Gusheng Tang, Shenglan Gong, Hui Cheng, Weiping Zhang, Jianmin Yang, Jianmin Wang & Xiaoxia Hu

  2. Department of Hematology, Changzheng Hospital, 200003, Shanghai, China

    Juan Du

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Wang, L., Du, J., Huang, A. et al. Chemotherapy vs. allogeneic transplantation as post molecular remission therapy in patients aged less than 60 years with Philadelphia-positive ALL. Bone Marrow Transplant 55, 245–248 (2020). https://doi.org/10.1038/s41409-019-0514-4

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