[Risk Factors of Leukemia-free Survival in Ph ALL Patients with Allogeneic Hematopoietic Stem Cell Transplantation].

Zhongguo Shi Yan Xue Ye Xue Za Zhi

Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Collaborate Innovation Center of Hematology, Suzhou 215006, Jiangsu Province, China.

Published: December 2017

AI Article Synopsis

  • The study investigates how the presence of BCR-ABL gene transcripts affects leukemia-free survival (LFS) and prognosis in patients with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph ALL) who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  • Out of 107 Ph ALL patients, a significant portion relapsed or died post-transplant, with BCR-ABL negative patients showing better outcomes in terms of cumulative incidence of relapse and survival compared to those with positive transcripts.
  • Factors such as BCR-ABL positivity, disease status prior to transplantation, and age significantly influenced the prognosis and risk of relapse in these patients.

Article Abstract

Objective: To explore the effect of BCR-ABL gene transcripts on Leukemia-free survival (LFS) and prognosis of patients with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph ALL) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods: The clinical data of 107 cases of Ph B-ALL patients received allo-HSCT from July 2006 to November 2014 in the First Affiliated Hospital of Soochow University were collected and the relationship between the clinical characteristics and LFS after transplantation was analyzed.

Results: Out of 107 Ph ALL patients (64 males and 43 females) with a median age of 30(7 to 54)years old, 35.5% (38/107) cases relapsed after transplantation within a median time of 6.9 (1.5 to 40.7) months. A total of 39 (36.4%) cases died within a median time of 19.8 (3.6 to 83.7) months after HSCT, of which 51.3% (20/39) due to disease relapse and 25.6% (10/39) due to infection. BCR-ABL gene transcripts of 49 cases turn into negative before transplantation, of which the expected 5-year cumulative incidence of relapse (CIR), non-relapse mortality (NRM) and overall survival (OS) were 26.5%, 29.5% and 41.6%, respectively. Another 49 cases still had a positive BCR-ABL gene transcripts before transplantation, of which the life expectancy of 5 year CIR, NRM and OS were 64.4%,8.9% and 48.9%, respectively. Compared with BCR-ABL positive patients, BCR-ABL negative patients showed a lower CIR (P<0.001), a higher NRM (P=0.030) and a similar OS (41.6% versus 48.9%, P=0.497). Multivariate analysis showed that BCR-ABL positive (P=0.016) and a disease statusphase ≥CR2 (P<0.001) before HSCT were independent risk factors for LFS, while the age underwent HSCT was the principal element affecting prognosis (P<0.001).

Conclusion: Both the relapse and infection are the main causes of death in the patients after transplantation. A disease status ≥CR2 and the BCR-ABL positive before transplantation are 2 independent risk factors of LFS in the patients with Ph ALL after allo-HSCT.

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http://dx.doi.org/10.7534/j.issn.1009-2137.2017.06.038DOI Listing

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