Download PDF
CC BY 4.0 · Indian J Med Paediatr Oncol 2023; 44(04): 408-413
DOI: 10.1055/s-0043-1761413
Original Article

A Retrospective Analysis of Autologous Stem Cell Transplantation Outcomes in Adult Philadelphia Chromosome Positive-Acute Lymphoblastic Leukemia

Kiran Kumar Satti 
1   Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Nikita Mehra 
1   Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
2   Department of Molecular Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Jayachandran Perumal Kalaiyarasi 
1   Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Venkataraman Radhakrishnan
1   Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Parathan Karunakaran 
1   Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Krishna Rathinam
1   Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Samson Mani
2   Department of Molecular Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
,
Prasanth Ganesan 
3   Department of Medical Oncology, Jawahar Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Introduction Philadelphia chromosome positivity (Ph + ) is a poor prognostic feature in adult acute lymphoblastic leukemia (ALL). Allogenic hematopoietic stem cell transplantation in first complete remission (CR1) is recommended. There is limited literature on the role of consolidation autologous stem cell transplantation (ASCT). This study was undertaken to assess the potential of consolidation ASCT in CR1 in adults with Ph + ALL.

Objectives The aim of this study was to analyze the safety and efficacy of ASCT in CR1 in adults with Ph + ALL.

Materials and Methods Adult patients diagnosed with Ph + ALL who underwent ASCT in CR1 after modified ALL-BFM95 protocol from 2015 to 2017 were included. Patients who achieved major molecular response or better were considered for ASCT with cyclophosphamide-total body irradiation regimen and peripheral blood stem cells infused on day 0. Toxicities as per Common Terminology Criteria for Adverse Event v4.0, disease-free survival (DFS), and overall survival (OS) were assessed. Inclusion criteria: Following patients were included—patients aged 18 years and above diagnosed with Ph + ALL; patients receiving BFM-95 induction chemotherapy protocol; patients who achieved CR after induction therapy; nonavailability of human leukocyte antigen match from a matched sibling donor or matched unrelated donor. Exclusion criteria: Patients not willing or unfit for ASCT and patients planned for allogenic hematopoietic stem cell transplantation were excluded.

Results Six adult patients with Ph + ALL underwent ASCT in CR1 (median age: 23 [range: 19–36] years, five patients were males [83%]). Imatinib was started at a median of 11 days from the start of induction IA (range: 10–21). Five patients achieved morphological CR after induction 1A and, one patient at the end of induction 1B. The median time to ASCT (from diagnosis) was 8 months (range: 6.4–13). All the six patients had disease relapse and died due to progressive ALL. The median DFS and OS were 19.2 months and 23.3 months, respectively.

Conclusion Consolidation ASCT yielded poor outcomes in this study. There was a significant delay from diagnosis to ASCT, which might have impacted the results.

Keywords

Philadelphia chromosome - autologous stem cell transplantation - acute lymphoblastic leukemia - consolidation therapy

Author's Contributions

All co-authors have reviewed the manuscript and have contributed substantially to the present study.


Ethics Approval

As this study was a retrospective analysis of patients with Ph + ALL who underwent ASCT between 2015 and 2017, IEC approval was not required per institutional policy. An IEC waiver form was obtained for the same.


Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Article published online:
17 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Secker-Walker LM, Prentice HG, Durrant J, Richards S, Hall E, Harrison G. MRC Adult Leukaemia Working Party. Cytogenetics adds independent prognostic information in adults with acute lymphoblastic leukaemia on MRC trial UKALL XA. Br J Haematol 1997; 96 (03) 601-610
    CrossrefPubMedGoogle Scholar
  • 2 Mrózek K, Harper DP, Aplan PD. Cytogenetics and molecular genetics of acute lymphoblastic leukemia. Hematol Oncol Clin North Am 2009; 23 (05) 991-1010 , v
    Google Scholar
  • 3 Fielding AK. How I treat Philadelphia chromosome-positive acute lymphoblastic leukemia. Blood 2010; 116 (18) 3409-3417
    CrossrefPubMedGoogle Scholar
  • 4 Rowe JM, Buck G, Burnett AK. et al; ECOG, MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood 2005; 106 (12) 3760-3767
    CrossrefPubMedGoogle Scholar
  • 5 Tanguy-Schmidt A, Rousselot P, Chalandon Y. et al. Long-term follow-up of the imatinib GRAAPH-2003 study in newly diagnosed patients with de novo Philadelphia chromosome-positive acute lymphoblastic leukemia: a GRAALL study. Biol Blood Marrow Transplant 2013; 19 (01) 150-155
    CrossrefPubMedGoogle Scholar
  • 6 Wetzler M, Watson D, Stock W. et al. Autologous transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia achieves outcomes similar to allogeneic transplantation: results of CALGB Study 10001 (Alliance). Haematologica 2014; 99 (01) 111-115
    CrossrefPubMedGoogle Scholar
  • 7 Giebel S, Labopin M, Gorin NC. et al. Improving results of autologous stem cell transplantation for Philadelphia-positive acute lymphoblastic leukaemia in the era of tyrosine kinase inhibitors: a report from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Eur J Cancer 2014; 50 (02) 411-417
    CrossrefPubMedGoogle Scholar
  • 8 Ganesan P, Jain H, Bagal B. et al. Outcomes in adolescent and young adult acute lymphoblastic leukaemia: a report from the Indian Acute Leukaemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC). Br J Haematol 2021; 193 (01) e1-e4
    CrossrefPubMedGoogle Scholar
  • 9 Liang SY. Monitoring MRD guided treatment outcome of adult patients with acute lymphoblastic leukemia using ALL-BFM95 based protocol. Blood 2017; 130 (Suppl. 01) 5040-5040
    Google Scholar
  • 10 Common Terminology Criteria for Adverse Events (CTCAE) | Protocol Development | CTEP [Internet] [cited 2023 Jan 30]. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm#ctc_40
  • 11 Jain P, Korula A, Deshpande P. et al. Adult acute lymphoblastic leukemia: limitations of intensification of therapy in a developing country. J Glob Oncol 2018; 4: 1-12
    CrossrefPubMedGoogle Scholar