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. 2019 Jun;8(6):2832-2839.
doi: 10.1002/cam4.2153. Epub 2019 Apr 23.

Combination chemotherapy plus dasatinib leads to comparable overall survival and relapse-free survival rates as allogeneic hematopoietic stem cell transplantation in Philadelphia positive acute lymphoblastic leukemia

Jeremy Chang  1 , Dan Douer  2 , Ibrahim Aldoss  3 , Golnaz Vahdani  1 , Ah-Reum Jeong  1 , Zunera Ghaznavi  2 , Sherry Zhang  4 , George Yaghmour  2 , Kum-Ja Lee  5 , Ashley Weissman  5 , Mojtaba Akhtari  2
Affiliations

Combination chemotherapy plus dasatinib leads to comparable overall survival and relapse-free survival rates as allogeneic hematopoietic stem cell transplantation in Philadelphia positive acute lymphoblastic leukemia

Jeremy Chang et al. Cancer Med. 2019 Jun.

Abstract

Background: The Philadelphia chromosome is associated with a poor prognosis in acute lymphoblastic leukemia (ALL). While hematopoietic stem cell transplantation (HSCT) has been regarded as a favorable treatment option in adult Philadelphia-positive (Ph+) ALL, its benefit is less clear in the era of newer generation tyrosine kinase inhibitors (TKIs) like dasatinib.

Methods: This was a retrospective study that analyzed the outcomes of adult patients with Ph+ ALL treated with either combination chemotherapy plus dasatinib or combination chemotherapy plus dasatinib followed by allogeneic HSCT.

Results: A total of 70 patients were included; 30 (42.9%) underwent allogeneic HSCT while 40 (57.1%) received only chemotherapy plus dasatinib. In comparing overall survival (OS) rates, results between the 2 groups were similar with a 1-year OS of 93.3% versus 100% (P = 0.20), 2-year OS of 89.8% versus 86.2% (P = 0.72), and 3-year OS of 76% versus 71.3% (P = 0.56) in the transplant versus nontransplant groups, respectively. The 3-year relapse-free survival (RFS) rates were also similar at 70.5% in the transplant group and 80.1% in the nontransplant group (P = 0.94). Subgroup analyses were performed for patients with specific poor prognostic factors (higher white blood count, older age, positive minimal residual disease status), but results again showed no significant survival difference between transplant and nontransplant patients.

Conclusions: While HSCT has historically led to a survival advantage in Ph+ ALL, the results of our study demonstrate that it may have a less beneficial role in the era of newer generation TKIs such as dasatinib.

Keywords: Dasatinib; Philadelphia chromosome; acute lymphoblastic leukemia; stem cell transplantation; survival.

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Figures

Figure 1
Figure 1
Minimal residual disease (MRD) status of transplant and nontransplant patients following induction therapy and at 100 days posttransplant
Figure 2
Figure 2
Overall survival since time of diagnosis
Figure 3
Figure 3
Relapse‐free survival since first complete response
See this image and copyright information in PMC

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