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Role of allo-HSCT in patients with Ph-like ALL in first complete remission
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Ph-like ALL is a high-risk subset of B-ALL associated with poor treatment response rates and high relapse rates.1 Although allo-HSCT is often recommended for these patients, positive evidence is limited to small, single-center studies.1 A large, multicenter, retrospective analysis assessed the benefit of allo-HSCT in adult patients with Ph-like ALL (n = 83) in CR1 compared to patients with Ph+ ALL (n = 271) and other subsets of Ph− B-ALL (n = 319).1 Results from this analysis were published in Transplantation and Cellular Therapy by Rahman et al.1 |
| Key learnings |
| Patients with Ph-like ALL undergoing allo-HSCT in CR1 had similar outcomes to other Ph− ALL subtypes, with comparable 3-year OS (66% vs 59%; p = 0.3), PFS (59% vs 54%; p = 0.4), and relapse rates (20% vs 22%; p = 0.7). |
| Patients with Ph-like ALL had worse outcomes compared to patients with Ph+ ALL, with lower 3-year OS (66% vs 75%; p < 0.001), PFS (59% vs 70%; p = 0.001), and higher 3-year relapse rates (20% vs 12%; p = 0.003), possibly due to the benefits of pre- and post-transplantation TKI therapy. |
| Multivariate analysis demonstrated that, while Ph+ ALL was associated with lower relapse rates (HR, 0.4; 95% CI, 0.3–0.7; p <0.001), MRD positivity prior to allo-HSCT was associated with increased relapse rates (HR, 2.9; 95% CI, 1.8–4.7; p <0.001); this highlights the utility of MRD as a prognostic indicator. |
| These findings suggest that allo-HSCT, combined with targeted second-line therapies, has the potential to improve the historically poor prognosis of patients with Ph-like ALL and achieve survival outcomes comparable to patients with other Ph− ALL subtypes. |
Abbreviations: ALL, acute lymphoblastic leukemia; allo-HSCT, allogeneic hematopoietic cell transplantation; B-ALL, B-cell ALL; CI, confidence interval; CR1, first complete remission; HR, hazard ratio; MRD, measurable residual disease; OS, overall survival; PFS, progression-free survival; PH, Philadelphia-chromosome; TKI, tyrosine kinase inhibitor.
- Rahman ZA, Othman T, Saliba RM, et al. A multicenter analysis of allogeneic transplant outcomes in adults with Philadelphia-like B-cell acute lymphoblastic leukemia in first complete remission. Transplant Cell Ther. Online ahead of print. DOI:10.1016/j.jtct.2024.09.020
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