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

Autor: Dan Douer, Zunera Ghaznavi, Golnaz Vahdani, Ashley Weissman, George Yaghmour, Sherry Zhang, Ibrahim Aldoss, Jeremy Chang, Mojtaba Akhtari, Kum-Ja Lee, Ah-Reum Jeong
Jazyk: angličtina
Rok vydání: 2019
Předmět:
0301 basic medicine
Oncology
Male
Cancer Research
Neoplasm
Residual
medicine.medical_treatment
Dasatinib
Graft vs Host Disease
Hematopoietic stem cell transplantation
0302 clinical medicine
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
Medicine
In Situ Hybridization
Fluorescence
Original Research
Hematopoietic Stem Cell Transplantation
Combination chemotherapy
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Prognosis
Combined Modality Therapy
Treatment Outcome
030220 oncology & carcinogenesis
Female
Tyrosine kinase
medicine.drug
Adult
medicine.medical_specialty
acute lymphoblastic leukemia
Philadelphia chromosome
lcsh:RC254-282
stem cell transplantation
survival
03 medical and health sciences
Young Adult
Internal medicine
Humans
Transplantation
Homologous
Radiology
Nuclear Medicine and imaging
Aged
Retrospective Studies
Chemotherapy
business.industry
Clinical Cancer Research
Retrospective cohort study
medicine.disease
Minimal residual disease
030104 developmental biology
business
Zdroj: Cancer Medicine
Cancer Medicine, Vol 8, Iss 6, Pp 2832-2839 (2019)
ISSN: 2045-7634
Popis: 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.
Databáze: OpenAIRE
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