Emre Tekgündüz1, Hakan Göker2, Leylagül Kaynar3, İsmail Sarı4, Çiğdem Pala3, Mehmet Hilmi Doğu4, Erman Öztürk5, Burhan Turgut6, Serdal Korkmaz7, Ayşegül Tetik8, Yahya Büyükaşık2, Sibel Kabukçu Hacıoğlu4, Sinem Civriz Bozdağ8, Evren Özdemir9, Fevzi Altuntaş8. 1. Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey. Electronic address: emretekgunduz@yahoo.com. 2. Department of Internal Medicine, Division of Hematology, Hacettepe University Medical School, Ankara, Turkey. 3. Department of Internal Medicine, Division of Hematology, Erciyes University Medical School, Kayseri, Turkey. 4. Department of Internal Medicine, Division of Hematology, Pamukkale University Medical School, Denizli, Turkey. 5. Department of Internal Medicine, Division of Hematology, Koç University Medical School, Istanbul, Turkey. 6. Department of Internal Medicine, Division of Hematology, Namık Kemal University Medical School, Tekirdağ, Turkey. 7. Department of Internal Medicine, Division of Hematology, Cumhuriyet University Medical School, Sivas, Turkey. 8. Hematology and Stem Cell Transplantation Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey. 9. Department of Internal Medicine, Division of Oncology, Hacettepe University Medical School, Ankara, Turkey.
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. 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.
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.
Authors: M N Lyu; E L Jiang; Y He; D L Yang; Q L Ma; A M Pang; W H Zhai; J L Wei; Y Huang; G X Zhang; R L Zhang; S Z Feng; M Z Han Journal: Zhonghua Xue Ye Xue Za Zhi Date: 2020-05-14