Comparison of allogeneic hematopoietic stem cell transplantation and TKI combined with chemotherapy for adult philadelphia chromosome positive acute lymphoblastic leukemia: a systematic review and meta‐analysis

Zeng, Qiang; Xiang, Bing; Liu, Zhigang

doi:10.1002/cam4.4413

Cited by 6 publications

(4 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The allo-HSCT rate was particularly low (17% and 20%) in these studies [ 41 , 45 ]. These data are supported by two recent meta-analyses that compared efficacy of allo-HSCT to chemotherapy or auto-HSCT [ 31 , 75 ]. Analysis combining data from pre-TKIs and TKIs eras found significant survival benefit of allo-HSCT due to lower CIR, but with higher TRM rates.…”

Section: Allogeneic Hematopoietic Stem Cellmentioning

confidence: 62%

Treatment of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Adults

Saleh

Fernández

Pasquier

2022

Cancers

View full text Add to dashboard Cite

Philadelphia-chromosome positive acute lymphoblastic leukemia (Ph+ ALL) is the most common subtype of B-ALL in adults and its incidence increases with age. It is characterized by the presence of BCR-ABL oncoprotein that plays a central role in the leukemogenesis of Ph+ ALL. Ph+ ALL patients traditionally had dismal prognosis and long-term survivors were only observed among patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in first complete remission (CR1). However, feasibility of allo-HSCT is limited in this elderly population. Fortunately, development of increasingly powerful tyrosine kinase inhibitors (TKIs) from the beginning of the 2000′s dramatically improved the prognosis of Ph+ ALL patients with complete response rates above 90%, deep molecular responses and prolonged survival, altogether with good tolerance. TKIs became the keystone of Ph+ ALL management and their great efficacy led to develop reduced-intensity chemotherapy backbones. Subsequent introduction of blinatumomab allowed going further with development of chemo free strategies. This review will focus on these amazing recent advances as well as novel therapeutic strategies in adult Ph+ ALL.

show abstract

Section: Allogeneic Hematopoietic Stem Cellmentioning

confidence: 62%

Treatment of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Adults

Saleh

Fernández

Pasquier

2022

Cancers

View full text Add to dashboard Cite

show abstract

“…Two recent meta-analyses demonstrate a survival advantage for Allo-SCT with the use of imatinib, but the advantage seems to disappear with newer TKIs due to their greater efficacy compared to imatinib, as well as the TRM rate of Allo-SCT [22,23]. Considering the financial burden of newer TKIs and novel therapies in resource-limited countries, Allo-SCT continues to be an attractive option for our patients when under treatment with curative intent.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Philadelphia Positive Acute Lymphoblastic Leukemia in Adolescent and Young Adults

Ahmed¹,

Ahmed²,

Awan³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundPhiladelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) accounts for 25% of acute lymphoblastic leukemia cases in the adolescent and young adult (AYA) age subgroup. It is associated with poor outcomes and is considered a standard indication for allogeneic stem cell transplant (Allo-SCT). Improved outcomes have been reported with addition of tyrosine kinase inhibitors (TKIs) to chemotherapy in children and the role of Allo-SCT is now being debated in the first remission. Complete response (CR) at three months is associated with improved survival even without Allo-SCT in first CR. In this study, we have analyzed disease-free survival (DFS), overall survival (OS), and factors affecting survival outcomes of Ph+ ALL in the AYA subgroup, in resource-limited settings treated with chemotherapy and TKIs. Materials and methodsThis is a retrospective, multicenter cohort study of Ph+ ALL AYA patients, aged 18-40 years, and registered between January 2015 and December 2020. Primary objectives are to calculate disease-free survival (DFS) and overall survival (OS). Secondary objectives are to identify prognostic factors affecting response rates and outcomes. List of cases was obtained from hospital information system (HIS) and data were collected from patient case notes and electronic medical records. Data analysis was done utilizing the SPSS statistical program (Armonk, NY: IBM Corp.). ResultsForty-nine patients were identified with Ph+ ALL with a median age of 23 years (range: 18-40 years) and a male-to-female ratio of 2.5:1. None of the patients had central nervous system (CNS) disease. White cell count was >30,000 per mm 3 in 26% of patients, while 13% had additional cytogenetic abnormalities. Thirtythree percent patients received adult (hyper-cyclophosphamide, vincristine, Adriamycin, and dexamethasone {CVAD}) protocols while 67% received pediatric-inspired (Berlin-Frankfurt-Munster {BFM} 2000 or UK-ALL 2003/2011) protocols. TKI therapy was received by 66% of patients during treatment (early: 37%; late: 29%) and 34% did not receive TKIs due to financial constraints. CR after induction was achieved in 69% cases. Induction mortality was 16%. The median DFS for the entire cohort was 27 months (0.93-53.06) and the median OS was 29 months (8.89-49.10). The median OS in Allo-SCT group was not reached vs 8.0±8.8 months (p=0.05) with chemotherapy only. The OS was significantly better in patients with no additional cytogenetic abnormalities, pediatric-inspired chemotherapy protocols, early use of TKIs in induction phase, Allo-SCT, and post-Allo-SCT use of TKIs. ConclusionAddition of TKIs to pediatric-inspired chemotherapy protocols in Ph+ ALL AYA patients and Allo-SCT results in better overall survival. TKI availability remains a significant issue in low-income countries due to significant financial burden on the patients. Allo-SCT continues to be an attractive option, particularly in low-income countries providing an option for cure in Ph+ ALL.

show abstract

“…36 The efficacy of even more potent TKIs, such as ponatinib, has called into the question the need for HCT for adults with Ph+ ALL in CR1, especially for those achieving MRD negativity early in the course of chemotherapy. [37][38][39] Before the development of MRD testing, HCT was also associated with improved OS for adults with standard risk (Ph-negative) ALL. 40 However, increasingly MRD testing is used to guide decisionmaking for HCT in CR1 in adults with Ph-negative ALL.…”

Section: Hct In Older Adults With Lymphoid Malignanciesmentioning

confidence: 99%

“…The development of tyrosine kinase inhibitors (TKIs), such as imatinib and dasatinib, greatly improved OS for patients with Ph + ALL and increased the efficacy of chemotherapy‐only regimens 36 . The efficacy of even more potent TKIs, such as ponatinib, has called into the question the need for HCT for adults with Ph+ ALL in CR1, especially for those achieving MRD negativity early in the course of chemotherapy 37–39 …”

Section: Hct In Older Adults With Lymphoid Malignanciesmentioning

confidence: 99%

Age barriers in allogeneic hematopoietic cell transplantation: Raising the silver curtain

Munshi,

McCurdy

2024

American J Hematol

View full text Add to dashboard Cite

Allogeneic hematopoietic cell transplantation (HCT) is no longer exclusively for the young. With an aging population, development of non‐intensive remission‐inducing strategies for hematologic malignancies, and novel graft‐versus‐host disease‐prevention platforms, an older population of patients is pursuing HCT. The evolving population of HCT recipients requires an overhaul in the way we risk‐stratify and optimize patients prior to HCT. Here, we review the history and current state of HCT for older adults and propose an assessment and intervention flow to bridge the gaps in today's clinical guidelines.

show abstract

Comparison of allogeneic hematopoietic stem cell transplantation and TKI combined with chemotherapy for adult philadelphia chromosome positive acute lymphoblastic leukemia: a systematic review and meta‐analysis

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 6 publications

References 77 publications

Treatment of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Adults

Treatment of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in Adults

Outcomes of Philadelphia Positive Acute Lymphoblastic Leukemia in Adolescent and Young Adults

Age barriers in allogeneic hematopoietic cell transplantation: Raising the silver curtain

Contact Info

Product

Resources

About