ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ADULT PHILADELPHIA-POSITIVE ACUTE LYMPHOBLASTIC LEUKEMIA: DOES MINIMAL RESIDUAL DISEASE BEFORE TRANSPLANTATION MATTER FOR LONG TERM OUTCOME?
Author(s): ,
Irati Ormazabal Velez
Affiliations:
Hematología y Hemoterapia,Hospital Universitario La Princesa,Madrid,Spain
,
Angela Figuera Alvarez
Affiliations:
Hematología y Hemoterapia,Hospital Universitario La Princesa,Madrid,Spain
,
Juan Luis Steegmann Olmedillas
Affiliations:
Hematología y Hemoterapia,Hospital Universitario La Princesa,Madrid,Spain
,
Rafael De la Cámara Llanza
Affiliations:
Hematología y Hemoterapia,Hospital Universitario La Princesa,Madrid,Spain
Ana García-Noblejas Moya
Affiliations:
Hematología y Hemoterapia,Hospital Universitario La Princesa,Madrid,Spain
EHA Library. Figuera Álvarez Á. Jun 15, 2019; 267264; PS963
Ángela Figuera Álvarez
Ángela Figuera Álvarez
Contributions
Abstract

Abstract: PS963

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background
Allogeneic hematopoietic stem cell transplantation (HSCT) is still the goal standard of care in Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) in adults with curative intention, though the introduction on tyrosin kinase inhibitors (TKI). Because some controversy on the importance of minimal residual disease (MRD) exists, we decided to evaluate our experience.

Aims
The primary endpoint was evalute the impact of positive MRD on survival, as well as the incidence of disease-free survival (DFS) and overall survival (OS). Secondary endpoints refined acute graft vs. host disease (aGvHD) and chronic GvHD (cGvHD) incidence, relapse incidence (RI), and non-relapse mortality (NRM).

Methods
Between 1993 and 2018, 45 HSCT were performed in 43 patients with Ph+ ALL in our hospital (2 double alloHSCT; 2,4%). Median age was 42 years (17-66), 55,8% of the patients were male and 44,2% were <40 years. Disease status before transplant was divided in 74,4% CR1 (n=32), 18,6% CR2 (n=8) and 7% active disease (n=3). MRD was available in 37 cases: 32,4% (n=12) were positive and 54,1% (n=20) negative by PCR, and 5,4% (n=2) has positive and 8,1% (n=3) negative cytogenetic, respectively. CNS was infiltrated in 8 cases (18,6%) and extramedular disease was detected in 13 cases (30,2%). TKI was employed in 24 cases (55,8%).

Results
With a median follow up of 6 years (2 months-23 years), the whole cohort DFS an OS rates were 51,2% and 55,8%, respectively. MRD positive before HSCT was related with worse outcome (p<0,05%). 

The incidence of grade II-IV aGvHD was 28,2% (n=11) and cGvHD 30,8% (n=12). Four patients (10,3%%) developed extensive cGvHD.

Relapse incidence was 25,6% (n=11) with a median time of 16 months (3-62). The incidence of NRM was 34,9% (n=15). The causes in order of frequency were pneumonia or respiratory failure (n=6; 31,6%) an septic shock (n=3; 15,8%).

Conclusion
In our cohort was highlghted the importance of achieving negative MRD before HSCT. An important goal in the near future should be the achievement of MRD negative before HSCT with the employment of current potent TKIs.

Session topic: 2. Acute lymphoblastic leukemia - Clinical

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