Philadelphia-positive acute lymphoblastic leukemia in daily practice: A multicenter experience

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Background: The prognosis of Philadelphia-positive acute lymphoblastic leukemia (Ph+ALL) is generally poor. Currently, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only accepted therapy with curative potential. Herein, we report our experience with Ph+ALL patients treated off-study. Methods: Data were collected from medical records of Ph+ALL patients diagnosed between 2005 and 2012. Survival rates were calculated using the Kaplan-Meier method and the log-rank test was used for comparison between groups. Results: This retrospective study included 41 patients (21 females and 20 males) from 7 centers in Turkey. The median age of the patients was 42 years (range, 19-70 years). Thirty (73%) patients received TKI and concurrent chemotherapy, 10 (24%) patients received chemotherapy alone and 1 (3%) patient received TKI alone. Of the patients receiving TKI, 24 (77%) received imatinib and 7 (23%) received dasatinib as induction therapy. Following induction therapy, 77% and 10% of the patients achieved complete hematologic remission and complete response with incomplete hematologic recovery, respectively. Eight (20%) patients had relapsed/resistant disease and received rescue therapy. The most common complication during therapy was febrile neutropenia (n=7, 17%). The induction mortality rate was 5% (n=2). Allo-HSCT was performed in 16 (39%) patients, 12 (75%) of whom underwent HSCT in first complete remission. Donor sources were matched siblings in 14 (88%) and unrelated donors in 2 (12%) patients. Fifteen (37%) patients died during follow-up. The Kaplan-Meier analysis revealed a median overall survival (OS) period of 12 months (range, 1-86 months) for all patients. The median OS period was 17 months (range, 5-86 months) and 2 months (range, 1-24 months) for patients who did or did not undergo HSCT, respectively (p=0.014). The Kaplan-Meier estimate of OS was 69.3% at 12 months and 49.1% at 24 months, for all patients. Conclusions: Allo-HSCT is the most important denominator of survival and the only curative therapy for Ph+ALL patients. For patients without a suitable donor or who are unable to undergo HSCT, TKI with concurrent chemotherapy is a reasonable alternative.