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Outcomes following relapse post allo-HCT in patients with Ph+ ALL
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A retrospective analysis of outcomes following relapse after allogeneic hematopoietic cell transplantation (allo-HCT) in patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) was reported in the American Journal of Hematology. The analysis included adult patients with ALL (N = 290) who received their first allo-HCT and subsequently relapsed between 2006 and 2023 at City of Hope Hospital, Duarte, US. Morphologic relapse was defined as ≥5% bone marrow (BM) blasts, extramedullary/lymph node disease (LND), or central nervous system (CNS) involvement. Measurable residual disease (MRD) relapse was defined as ≥0.01% blasts by flow cytometry or BCR::ABL1 transcripts by PCR. |
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The retrospective analysis showed that 2-year progression-free survival (PFS) and overall survival (OS) were:
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The use of novel immunotherapies improved PFS for systemic relapses, although there was no significant difference in OS. |
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Ponatinib was effective against resistant ABL kinase domain mutations, but no superiority was noted over older-generation tyrosine kinase inhibitors (TKIs) when used as the first TKI post-HCT relapse.
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High relapse and treatment-related mortality were observed with second allo-HCT and donor lymphocyte infusions. |
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Understanding the type of relapse (morphologic vs MRD), regular monitoring for MRD, and timely intervention with potent TKIs or immunotherapies is crucial for improving post-HCT outcomes in adult patients with Ph+ ALL. |
References
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