Los Angeles County - University of Southern California, Los Angeles, California.
Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Norris Cancer Center, Los Angeles, California.
Cancer Med. 2019 Jun;8(6):2832-2839. doi: 10.1002/cam4.2153. Epub 2019 Apr 23.
The Philadelphia chromosome is associated with a poor prognosis in acute lymphoblastic leukemia (ALL). While hematopoietic stem cell transplantation (HSCT) has been regarded as a favorable treatment option in adult Philadelphia-positive (Ph+) ALL, its benefit is less clear in the era of newer generation tyrosine kinase inhibitors (TKIs) like dasatinib.
This was a retrospective study that analyzed the outcomes of adult patients with Ph+ ALL treated with either combination chemotherapy plus dasatinib or combination chemotherapy plus dasatinib followed by allogeneic HSCT.
A total of 70 patients were included; 30 (42.9%) underwent allogeneic HSCT while 40 (57.1%) received only chemotherapy plus dasatinib. In comparing overall survival (OS) rates, results between the 2 groups were similar with a 1-year OS of 93.3% versus 100% (P = 0.20), 2-year OS of 89.8% versus 86.2% (P = 0.72), and 3-year OS of 76% versus 71.3% (P = 0.56) in the transplant versus nontransplant groups, respectively. The 3-year relapse-free survival (RFS) rates were also similar at 70.5% in the transplant group and 80.1% in the nontransplant group (P = 0.94). Subgroup analyses were performed for patients with specific poor prognostic factors (higher white blood count, older age, positive minimal residual disease status), but results again showed no significant survival difference between transplant and nontransplant patients.
While HSCT has historically led to a survival advantage in Ph+ ALL, the results of our study demonstrate that it may have a less beneficial role in the era of newer generation TKIs such as dasatinib.
费城染色体与急性淋巴细胞白血病（ALL）的预后不良有关。虽然造血干细胞移植（HSCT）被认为是成人费城阳性（Ph+）ALL 的一种有利治疗选择，但在新型酪氨酸激酶抑制剂（TKI）如达沙替尼的时代，其益处并不明确。
这是一项回顾性研究，分析了接受联合化疗加达沙替尼或联合化疗加达沙替尼后行异基因 HSCT 的成人 Ph+ ALL 患者的结局。
共纳入 70 例患者，其中 30 例（42.9%）接受异基因 HSCT，40 例（57.1%）仅接受化疗加达沙替尼治疗。比较总生存（OS）率，两组结果相似，移植组 1 年 OS 为 93.3%对 100%（P=0.20），2 年 OS 为 89.8%对 86.2%（P=0.72），3 年 OS 为 76%对 71.3%（P=0.56）；非移植组 3 年无复发生存（RFS）率分别为 70.5%和 80.1%（P=0.94）。对具有特定不良预后因素（更高的白细胞计数、年龄较大、微小残留病阳性）的患者进行亚组分析，但结果再次表明，移植与非移植患者的生存无显著差异。
虽然 HSCT 历史上使 Ph+ ALL 患者的生存获益，但本研究结果表明，在新型 TKI 如达沙替尼的时代，它的作用可能不太有益。
