Improved post‐transplant outcomes since 2000 for Ph‐positive acute lymphoblastic leukemia in first remission: A study from the EBMT Acute Leukemia Working Party

Allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative treatment for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) in their first complete remission (CR1). Recent results using the combination of blinatumomab and second- or third-generation tyrosine kinase inhibitors have challenged the necessity of allo-HCT in CR1. Here we assessed real-world changes over time in transplant characteristics and outcomes in adult patients with Ph+ ALL in CR1, using a large dataset from the European Society for Blood and Marrow Transplantation registry. A total of 3292 patients (45% female; median age 45 years) who underwent allo-HCT from 2001 to 2020 were included. Over four periods (2001-2005, 2006-2010, 2011-2015, and 2016-2020), the 3-year cumulative incidence of relapse decreased from 41% to 19%, and non-relapse mortality decreased from 25% to 17% (<i>p</i> < 0.001 for both). Correspondingly, 3-year leukemia-free survival (LFS) improved from 34% to 64%, and overall survival (OS) from 47% to 75% (<i>p</i> < 0.001 for both). Graft versus host disease-free and relapse-free survival also improved from 26% to 49% (<i>p</i> < 0.001). Factors negatively affecting LFS included older age, male gender, male donor and measurable residual disease (MRD) positivity pre-transplant, while total body conditioning (TBI) positively affected LFS. OS was positively influenced by younger age, female gender, matched sibling donor, TBI, and T cell depletion. Importantly, improvement in post-transplant outcomes over time was observed regardless of pre-transplant MRD status. In conclusion, we observed an impressive improvement over time in post-transplant outcomes of Ph+ ALL. These large-scale data can serve as a benchmark for future studies.

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Publication Details

Journal
HemaSphere
Published
2025-04-01
DOI
https://doi.org/10.1002/hem3.70117
Citations
1
Primary Topic
Acute Lymphoblastic Leukemia research
Type
article
Field-Weighted Citation Impact
1.88
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article

Improved post‐transplant outcomes since 2000 for Ph‐positive acute lymphoblastic leukemia in first remission: A study from the EBMT Acute Leukemia Working Party

Nicolaus Martin Kröger, Myriam Labopin, Éolia Brissot, Marie Balsat et al.
1 citations
HemaSphere
Acute Lymphoblastic Leukemia research
1.88
article

Improved post‐transplant outcomes since 2000 for Ph‐positive acute lymphoblastic leukemia in first remission: A study from the EBMT Acute Leukemia Working Party

Nicolaus Martin Kröger, Myriam Labopin, Éolia Brissot, Marie Balsat, Gèrard Socié, Mohamad Mohty, Didier Blaise, Fabio Ciceri, Alexander Kulagin, Ali Bazarbachi, Eva Wagner-Drouet, Xavier Poiré, Ibrahim Yakoub‐Agha, Iman Abou Dalle, Thomas A. Schroeder, Urpu Salmenniemi, Arnon Nagler, Depei Wu, Sebastian Giebel
article en
1 citations

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) remains a curative treatment for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) in their first complete remission (CR1). Recent results using the combination of blinatumomab and second- or third-generation tyrosine kinase inhibitors have challenged the necessity of allo-HCT in CR1. Here we assessed real-world changes over time in transplant characteristics and outcomes in adult patients with Ph+ ALL in CR1, using a large dataset from the European Society for Blood and Marrow Transplantation registry. A total of 3292 patients (45% female; median age 45 years) who underwent allo-HCT from 2001 to 2020 were included. Over four periods (2001-2005, 2006-2010, 2011-2015, and 2016-2020), the 3-year cumulative incidence of relapse decreased from 41% to 19%, and non-relapse mortality decreased from 25% to 17% (<i>p</i> < 0.001 for both). Correspondingly, 3-year leukemia-free survival (LFS) improved from 34% to 64%, and overall survival (OS) from 47% to 75% (<i>p</i> < 0.001 for both). Graft versus host disease-free and relapse-free survival also improved from 26% to 49% (<i>p</i> < 0.001). Factors negatively affecting LFS included older age, male gender, male donor and measurable residual disease (MRD) positivity pre-transplant, while total body conditioning (TBI) positively affected LFS. OS was positively influenced by younger age, female gender, matched sibling donor, TBI, and T cell depletion. Importantly, improvement in post-transplant outcomes over time was observed regardless of pre-transplant MRD status. In conclusion, we observed an impressive improvement over time in post-transplant outcomes of Ph+ ALL. These large-scale data can serve as a benchmark for future studies.

HemaSphereVol. 9(4)
Cliniques Universitaires Saint-Luc (BE), Inserm (FR), Universität Hamburg (DE), Johannes Gutenberg University Mainz (DE), First Pavlov State Medical University of St. Petersburg (RU), Sheba Medical Center (IL), Helsinki University Hospital (FI), Centre Hospitalier Universitaire de Lille (FR), Soochow University (CN), Sorbonne Université (FR), University Medical Center of the Johannes Gutenberg University Mainz (DE), Hôpital Saint-Antoine (FR), American University of Beirut Medical Center (LB), University Medical Center Hamburg-Eppendorf (DE), Hôpital Lyon Sud (FR), Essen University Hospital (DE), IRCCS Ospedale San Raffaele (IT), Centre de Recherche Saint-Antoine (FR), Hôpital Saint-Louis (FR), The Maria Sklodowska-Curie National Research Institute of Oncology (PL), First Affiliated Hospital of Soochow University (CN)
Good health and well-being
Openalex Percentile: Top 17%
Acute Lymphoblastic Leukemia research
1.88
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