All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit Know ALL.

The ALL Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy

Introducing

Now you can personalise
your ALL Hub experience!

Bookmark content to read later

Select your specific areas of interest

View content recommended for you

Find out more
  TRANSLATE

The ALL Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the ALL Hub cannot guarantee the accuracy of translated content. The ALL Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.

Steering CommitteeAbout UsNewsletterContact
LOADING
You're logged in! Click here any time to manage your account or log out.
LOADING
You're logged in! Click here any time to manage your account or log out.

The ALL Hub is an independent medical education platform, sponsored by Jazz Pharmaceuticals, Amgen, and Pfizer. The funders are allowed no direct influence on our content. The levels of sponsorship listed are reflective of the amount of funding given. View funders.

2024-10-25T08:10:05.000Z

Role of allo-HSCT in patients with Ph-like ALL in first complete remission

Oct 25, 2024
Share:
Learning objective: After reading this article, learners will be able to cite a new clinical development in acute lymphoblastic leukemia.

Bookmark this article


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. 

  1. 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

Newsletter

Subscribe to get the best content related to ALL delivered to your inbox