Philadelphia-positive B-lymphoblastic leukemia in a middle-income country - A real-world multicenter cohort.

Autor: Silva WF; Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil. Electronic address: wellington.fernandes@hc.fm.usp.br., Silverio A; Centro de Pesquisas Oncológicas (CEPON), Florianópolis, Brazil., Duarte BKL; Hospital de Clínicas da Universidade Estadual de Campinas (Unicamp), Unicamp, Campinas, Brazil., Aguiar TF; HEMORIO - Instituto de Hematologia Arthur de Siqueira Cavalcante, Rio de Janeiro, Brazil., Bendlin RM; Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, Brazil., Massaut IHB; Centro de Pesquisas Oncológicas (CEPON), Florianópolis, Brazil., Pagnano KBB; Hospital de Clínicas da Universidade Estadual de Campinas (Unicamp), Unicamp, Campinas, Brazil., Velloso EDRP; Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil., Rocha V; Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil., Rego EM; Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: Leukemia research [Leuk Res] 2021 Nov; Vol. 110, pp. 106666. Date of Electronic Publication: 2021 Jul 13.
DOI: 10.1016/j.leukres.2021.106666
Abstrakt: Outside of clinical trials, few studies have addressed the outcomes of Ph+ acute lymphoblastic leukemia (ALL) in adults, especially from developing world. In this study, we conducted a multicenter analysis on the outcomes of patients aged > 15 years with Ph+ ALL, aiming to get to know an overview of the Brazilian experience as well as to explore baseline factors associated with relapse and mortality in our setting. Over these 10 years, patients were treated with diverse protocols, all of them always combined with a frontline tyrosine-kinase inhibitor. A total of 123 Ph+ ALL patients was included. Imatinib was the first line TKI in 97 %. The complete response rate was 79 %. The early death rate was 15 %, being associated with increasing age at diagnosis (p = 0.06). The use of intensive versus attenuated induction regimen was not associated with higher induction mortality (p = 0.99). Overall, 29 % of patients aged ≤ 60 years underwent allogeneic transplantation, 87 % in first CR. 4-year overall survival (OS) and relapse-free survival were 25 % and 24 %, respectively. The incidence of relapse (death as a competitor) was 29 %, while the non-relapse mortality was 42 %. Only age was independently associated with OS, and lactate dehydrogenase level and central nervous disease at diagnosis were related to relapse in our cohort. This is the first historical cohort multicenter study on Ph+ ALL from Brazil. Reporting these outcomes is essential to encourage public policies to expand access to new drugs and transplantation in middle-income countries.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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