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Favorable prognosis in Philadelphia chromosome‐positive B‐cell acute lymphoblastic leukemia patients following hematopoietic stem cell transplantation

The prognosis for adult patients with acute lymphoblastic leukemia (ALL) is poor. Standard risk subsets of ALL patients have a survival rate of about 50% that can further reduce to <10% in those with Philadelphia chromosome-positive (Ph+) ALL (1, 2). However, tyrosine kinase inhibitors (TKI) have remarkably improved outcomes in patients with Ph+ ALL (3). Here, we compare the outcomes of newly diagnosed adult Ph+ ALL and Ph-negative (Ph ) B-cell ALL (B-ALL) cases. We retrospectively analyzed 35 consecutive, newly diagnosed cases of B-ALL admitted to our center between January 2003 and September 2014, who were treated with standard induction chemotherapy. Imatinib was administered to patients with Ph+ ALL. Thirty-five patients were included (males, 18; females, 17; Ph+ ALL, 14; Ph B-ALL, 21; median age, 41 yr; range, 16–64 yr). The complete remission rate (CRR) for the first induction therapy for Ph+ ALL and Ph ALL was 100% and 90%, respectively. The five-yr overall survival (5yOS) of Ph+ ALL and Ph ALL patients was 64% and 63%, respectively (p = 0.45). The five-yr progression free survival (5yPFS) for Ph+ ALL and Ph ALL patients was 85% and 62%, respectively (p = 0.30). Next, we analyzed 24 patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT; Ph+ ALL,12; Ph ALL, 12). Patient characteristics of the patients are shown in Table 1. The 5yOS following HSCT of Ph+ ALL and Ph ALL patients was 71% and 38%, respectively (p = 0.13). The 5yPFS after HSCT of Ph+ ALL and Ph ALL patients was 72% and 33%, respectively (p = 0.04). The five-yr cumulative incidence of relapse after HSCT for Ph+ ALL and Ph ALL patients was 8% and 50%, respectively (p = 0.03). We consider two main reasons for the improved prognosis of patients with Ph+ ALL. First, TKIs have aided most patients with Ph+ ALL in achieving complete remission (3). The CRR for the first induction therapy for Ph+ ALL patients was 100% in our study. Second, the survival rate of non-myeloablative HSCT has increased in the elderly (4). Although one-third of patients with Ph+ ALL received non-myeloablative HSCT, the HSCT outcome was not as low as that in other high-risk ALL, one-fifth of whom received non-myeloablative HSCT. Conversely, the prognosis of the other high-risk ALL in this study was lower than that reported elsewhere (4, 5). One potential