Rahman Zaid Abdel, Othman Tamer, Saliba Rima M, Vanegas Yenny Alejandra Moreno, Mohty Razan, Ledesma Celina, Rondon Gabriela, Jain Nitin, Jabbour Elias, Pullarkat Vinod, Alkhateeb Hassan B, Kantarjian Hagop M, Greipp Patricia T, Nakamura Ryotaro, Kharfan-Dabaja Mohamed A, Champlin Richard E, Forman Stephen J, Shpall Elizabeth J, Litzow Mark R, Foran James M, Aldoss Ibrahim, Koller Paul B, Kebriaei Partow
Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
City of Hope National Medical Center, Duarte, California.
Transplant Cell Ther. 2024 Dec;30(12):1197-1205. doi: 10.1016/j.jtct.2024.09.020. Epub 2024 Sep 26.
Philadelphia-like acute lymphoblastic leukemia (Ph-like ALL) is a high-risk subset of B-cell ALL with a poor prognosis with conventional therapies. Diagnostic challenges and lack of standardized treatment protocols contribute to suboptimal outcomes. Additionally, while allogeneic hematopoietic cell transplantation (HCT) is frequently recommended in adults with Ph-like ALL given its high-risk nature, data supporting its role remains limited. We conducted a multicenter retrospective study evaluating outcomes of adult patients undergoing HCT in first complete remission (CR1) for Ph-like ALL compared to Philadelphia chromosome positive ALL (Ph-pos) and other B-cell Philadelphia negative (Ph-neg) ALL. Data was collected from five academic centers across the US, focusing on HCT outcomes for patients with ALL. Patients undergoing HCT in CR1 between 2006 and 2021 were included. Among 673 patients, 83 (12.3%) had Ph-like ALL, while 271 (40.3%) had Ph-pos and 319 (47.4%) had Ph-neg ALL. Outcomes following HCT in CR1 for Ph-like ALL were comparable to Ph-neg ALL, with no significant differences in 3-year overall survival (66% vs. 59%, P = .1), progression-free survival (59% and 54%, P = .1), or relapse rates (22% vs. 20%, P = .7). In contrast, Ph-pos ALL had superior outcomes; 3-year OS (75%, P < .001), PFS (70%, P = .001) and relapse (12%, P = .003), this is likely attributed to tyrosine kinase inhibitor therapy. Our study suggests that HCT, coupled with effective 2nd line therapies can possibly mitigate the poor prognosis associated with Ph-like ALL and offers promising outcomes for patients with Ph-like ALL.
费城样急性淋巴细胞白血病（Ph样ALL）是B细胞ALL的一个高危亚组，采用传统疗法预后较差。诊断挑战和缺乏标准化治疗方案导致治疗效果欠佳。此外，鉴于其高危性质，异基因造血细胞移植（HCT）常被推荐用于成年Ph样ALL患者，但支持其作用的数据仍然有限。我们进行了一项多中心回顾性研究，评估与费城染色体阳性ALL（Ph阳性）和其他B细胞费城阴性（Ph阴性）ALL相比，处于首次完全缓解（CR1）期接受HCT的成年Ph样ALL患者的预后。数据收集自美国五个学术中心，重点关注ALL患者的HCT结果。纳入2006年至2021年期间在CR1期接受HCT的患者。在673例患者中，83例（12.3%）患有Ph样ALL，271例（40.3%）患有Ph阳性ALL，319例（47.4%）患有Ph阴性ALL。Ph样ALL患者CR1期HCT后的预后与Ph阴性ALL相当，3年总生存率（66%对59%，P = 0.1）、无进展生存率（59%和54%，P = 0.1）或复发率（22%对20%，P = 0.7）均无显著差异。相比之下，Ph阳性ALL的预后更好；3年总生存率（75%，P < 0.001）、无进展生存率（70%，P = 0.001）和复发率（12%，P = 0.003），这可能归因于酪氨酸激酶抑制剂治疗。我们的研究表明，HCT联合有效的二线治疗可能减轻与Ph样ALL相关的不良预后，并为Ph样ALL患者提供有希望的预后。
