01 January 0001

The survival rate from relapsed Philadelphia-positive acute lymphoblastic leukaemia (ALL) is now almost twice as high as it was 20 years ago, according to a new analysis.

Patients whose leukaemia carries the Philadelphia chromosome comprise about 30% of adult ALL cases. They are at a raised mortality risk but may be suitable for allogeneic haematopoietic stem cell transplantation.

Following transplant, some patients experience relapse due to residual leukaemia cells avoiding destruction. Recent interventions have attempted to address this issue, such as newer-generation tyrosine kinase inhibitors, and immunotherapy such as blinatumomab, and CAR-T cell therapy. The option of a second transplant is also sometimes available.

So researchers led by Dr Ali Bazarbachi of the American University of Beirut, Lebanon, looked at two-year overall survival rates for such patients and how they have changed between 2000 and 2019.

The new study looked at data from cancer registries on 899 adults with relapsed Philadelphia chromosome-positive ALL who had an allogeneic haematopoietic stem cell transplantation.

The two-year overall survival rate after relapse rose from 27.8% for those relapsing between 2000-2004, to 54.8% between 2015-2019, despite patients being over a decade older at relapse.

There was also evidence that survival increased in line with the duration between transplant and relapse.

Dr Bazarbachi says: “In the subset of acute lymphoblastic leukaemia patients carrying the Philadelphia chromosome, post-transplant relapse occurs in up to 30% of the cases, and in earlier studies, long-term survival was dismal.

“However, several new therapeutic strategies have been recently approved for these patients, therefore it was important to study and compare the clinical outcomes between different time periods in the past 20 years.

“Our findings proved that the survival of these patients has significantly improved over time,” he added. “These large-scale real-world data can serve as a benchmark for future studies in this setting.”

Source:

Bazarbachi A, Labopin M, Aljurf M, Niittyvuopio R, Balsat M, Blaise D, Yakoub-Agha I, Grassi A, Reinhardt HC, Lenhoff S, Jindra P, Passweg J, Abou Dalle I, Stadler M, Lioure B, Ceballos P, Brissot E, Giebel S, Nagler A, Schmid C, Mohty M. (2022) “20-Year Steady Increase in Survival of Adult Patients with Relapsed Philadelphia-Positive Acute Lymphoblastic Leukemia Post Allogeneic Hematopoietic Cell Transplantation.” Clinical Cancer Research, doi: 10.1158/1078-0432.CCR-21-2675

Link: https://clincancerres.aacrjournals.org/content/early/2021/12/21/1078-0432.CCR-21-2675

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