Intensity of induction regimen and outcomes among adults with Ph+ALL undergoing allogeneic hematopoietic stem cell transplantation. (February 2023)

• Record Type: Journal Article
• Authors: Raman, Hari S.; Kim, Se Eun; DeAngelo, Daniel J.; Stevenson, Kristen E.; Neuberg, Donna; Winer, Eric S.; Wadleigh, Martha; Garcia, Jacqueline S.; Kim, Annette S.; Stone, Richard M.; Ho, Vincent T.; Luskin, Marlise R.
• Is Part Of: Leukemia research. Volume 125(2023)
• Publication Date: 2023-02
• Subjects: Adult Ph+ ALL -- alloHCT -- Cliinical outcomes; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2022.107004
• Languages: English
• ISSNs: 0145-2126

Abstract

Abstract: Tyrosine kinase inhibitors (TKIs) are essential for the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) and have allowed for effective, low intensity induction regimens including no or minimal chemotherapy. Whether the use of low intensity induction regimens impacts outcomes after allogeneic hematopoietic stem cell transplant (alloHCT) is less understood. We identified consecutive adult patients with Ph+ ALL undergoing alloHCT in first complete remission (CR1) at our center from 2010 to 2021 and examined the impact of pre-transplant induction intensity on outcomes. Among the 87 identified patients, 44 (51%) received low intensity induction and 43 (49%) received induction with high intensity chemotherapy. Patients receiving low intensity induction were older (median age 60 vs. 47 years, p < 0.01). Following induction, measurable residual disease (MRD) negativity by BCR::ABL1 RT-PCR was similar in the low and high intensity induction cohorts (54% and 52% respectively). Receipt of reduced intensity transplant conditioning was not associated with intensity of induction regimen (39% vs. 19% in low vs. high, respectively, p = 0.06). At a median follow-up of 21 months from transplant, there was no difference between low and high intensity induction with respect to 2-year disease-free survival (58% vs. 56%), 2-year overall survival (62% vs. 63%), 2-year cumulative incidence of relapse (9% vs. 17%), and 2-year non-relapse mortality (33% vs. 29%). We also found no difference in outcomes when patients were segmented by both induction and conditioning regimen intensities. Our retrospective analysis suggests that induction intensity does not impact post-transplant outcomes among patients with Ph+ ALL transplanted in CR1. Graphical Abstract: ga1 Highlights: TKIs have enabled the use of low intensity induction chemotherapy for Ph+ ALL. Low intensity induction induces CR with less toxicity than conventional induction. Induction intensity does not impact overall outcomes in Ph+ ALL transplanted in CR1. Low intensity induction with reduced intensity conditioning is effective in Ph+ ALL.