Clin Lymphoma Myeloma Leuk 2016 May;16(5):269-74

Adult Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Daily Practice: A Multicenter Experience.

Tekgündüz E1, Göker H2, Kaynar L3, Sarı İ4, Pala Ç3, Doğu MH4, Öztürk E5, Turgut B6, Korkmaz S7, Tetik A8, Büyükaşık Y2, Hacıoğlu SK4, Bozdağ SC8, Özdemir E9, Altuntaş F8.
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.
l="BACKGROUND" NlmCategory="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.

PATIENTS AND 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.