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LONG-TERM SURVIVAL OUTCOMES OF ADULT PHILADELPHIA CHROMOSOME-POSITIVE ACUTE LYMPHOBLASTIC LEUKEMIA PATIENTS TREATED WITH IMATINIB OR DASATINIB
Author(s):
Golnaz Vahdani
,
Golnaz Vahdani
Affiliations:
Department of Internal Medicine,LAC+USC Medical Center,Los Angeles, CA,United States
Ah-Reum Jeong
,
Ah-Reum Jeong
Affiliations:
Department of Internal Medicine,LAC+USC Medical Center,Los Angeles, CA,United States
Zunera Ghaznavi
,
Zunera Ghaznavi
Affiliations:
Keck School of Medicine,University of Southern California,Los Angeles, CA,United States
Wendy Hsiao
,
Wendy Hsiao
Affiliations:
Keck School of Medicine,University of Southern California,Los Angeles, CA,United States
Varsha Tulpule
,
Varsha Tulpule
Affiliations:
Department of Internal Medicine,LAC+USC Medical Center,Los Angeles, CA,United States
Mojtaba Akhtari
Mojtaba Akhtari
Affiliations:
Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases,University of Southern California Norris Comprehensive Cancer Center,Los Angeles, CA,United States
(Abstract release date: 05/18/17) EHA Library. Vahdani G. 05/18/17; 182358; PB1644
Golnaz Vahdani
Golnaz Vahdani
Contributions
PDF Abstract
Abstract

Abstract: PB1644

Type: Publication Only

Background

Acute lymphoblastic leukemia (ALL) with positive Philadelphia chromosome (Ph+) is a unique subset of ALL with poor prognosis. Recent studies have demonstrated improved survival outcomes in adult patients with Ph+ ALL with the use of tyrosine kinase inhibitors (TKIs) along with chemotherapy. However, there are very few studies that describe the comparative effectiveness of various TKIs in this patient population.

Aims
To characterize long-term survival outcomes including leukemia-free survival (LFS) and overall survival (OS) for Ph+ adult ALL patients treated with imatinib versus dasatinib.

Methods

Retrospective chart review was conducted at our institution. Patients >= 18 years old and diagnosed with Ph+ ALL between 2002 and 2015 were included. Analysis was done by intent to treat for patients initiated with imatinib or dasatinib at the time of Ph+ diagnosis. The primary endpoints were 2-year LFS and OS and secondary endpoints were complete molecular response (CMR; BCR-ABL1/ABL1 ratio <0.01% by PCR) and major molecular response (MMR; BCR-ABL1/ABL1 ratio <0.1% by PCR).

Results
Among 46 patients with Ph+ ALL, 74% (n=34) were in imatinib group and 17% (n=8) in dasatinib group; 9% were treated with other or no TKI (1 ponatinib and 3 with no TKI). Thirty-eight percent (n=13) of patients in imatinib group and 13% (n=1) in dasatinib group switched to a different TKI due to adverse effects or failure to achieve remission. There was a trend towards increased 2-year LFS for patients on dasatinib (HR 0.40, 95% CI: 0.14-1.14, p=0.09) and no difference in 2-year mortality (HR 1.00 95%CI: 0.46-2.17, p=0.99). Molecular response data was available for 61% (n=28) of patients; 75% of imatinib group achieved CMR or MMR (65% CMR) compared to 76% of dasatinib group (63% CMR) (p=0.98).

Conclusion

In conclusion, dasatinib, compared to imatinib, in combination with chemotherapy, may prolong LFS in patients with Ph+ ALL and may be a suitable first-line agent. Large, randomized studies are needed to better define a detailed treatment protocol in this high-risk patient population.

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Survival, Philadelphia chromosome, Acute lymphoblastic leukemia, Tyrosine kinase inhibitor

Abstract: PB1644

Type: Publication Only

Background

Acute lymphoblastic leukemia (ALL) with positive Philadelphia chromosome (Ph+) is a unique subset of ALL with poor prognosis. Recent studies have demonstrated improved survival outcomes in adult patients with Ph+ ALL with the use of tyrosine kinase inhibitors (TKIs) along with chemotherapy. However, there are very few studies that describe the comparative effectiveness of various TKIs in this patient population.

Aims
To characterize long-term survival outcomes including leukemia-free survival (LFS) and overall survival (OS) for Ph+ adult ALL patients treated with imatinib versus dasatinib.

Methods

Retrospective chart review was conducted at our institution. Patients >= 18 years old and diagnosed with Ph+ ALL between 2002 and 2015 were included. Analysis was done by intent to treat for patients initiated with imatinib or dasatinib at the time of Ph+ diagnosis. The primary endpoints were 2-year LFS and OS and secondary endpoints were complete molecular response (CMR; BCR-ABL1/ABL1 ratio <0.01% by PCR) and major molecular response (MMR; BCR-ABL1/ABL1 ratio <0.1% by PCR).

Results
Among 46 patients with Ph+ ALL, 74% (n=34) were in imatinib group and 17% (n=8) in dasatinib group; 9% were treated with other or no TKI (1 ponatinib and 3 with no TKI). Thirty-eight percent (n=13) of patients in imatinib group and 13% (n=1) in dasatinib group switched to a different TKI due to adverse effects or failure to achieve remission. There was a trend towards increased 2-year LFS for patients on dasatinib (HR 0.40, 95% CI: 0.14-1.14, p=0.09) and no difference in 2-year mortality (HR 1.00 95%CI: 0.46-2.17, p=0.99). Molecular response data was available for 61% (n=28) of patients; 75% of imatinib group achieved CMR or MMR (65% CMR) compared to 76% of dasatinib group (63% CMR) (p=0.98).

Conclusion

In conclusion, dasatinib, compared to imatinib, in combination with chemotherapy, may prolong LFS in patients with Ph+ ALL and may be a suitable first-line agent. Large, randomized studies are needed to better define a detailed treatment protocol in this high-risk patient population.

Session topic: 2. Acute lymphoblastic leukemia - Clinical

Keyword(s): Survival, Philadelphia chromosome, Acute lymphoblastic leukemia, Tyrosine kinase inhibitor

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