Publication Date:
2012-11-16
Description:
Abstract 816 We hypothesized that imatinib plus sequential chemotherapy would result in significant leukemia cell cytoreduction (molecular remission) in patients with Ph+ acute lymphoblastic leukemia (ALL), allowing collection of normal hematopoietic stem cells uncontaminated by residual BCR/ABL+ lymphoblasts and thus reduce the likelihood of relapse after autologous (auto) stem cell transplant (SCT) for patients 0.001 (less than MMR); however, the sample size was too small to analyze the effect of MRD on outcome. After a median follow up time of 5.1 years, 9 (47%) of 19 auto-SCT patients and 7 of 15 (47%) of the allo-SCT patients remain alive in continuous CR. Ten of the transplanted patients have relapsed (8 following auto-SCT and 2 following allo-SCT); relapses occurred at a median of 5.9 months following auto-SCT. The DFS (median, 5.5 vs 4.1 years; P=0.84) and OS (median, 6.0 years vs. not reached at 〉6 years; P=0.90) were similar between those who underwent auto- or allo-SCT (Panels C and D). We conclude that patients who have MRD at levels lower than or equal to MMR following auto-SCT have prolonged survival and that auto-SCT represents a safe and effective alternative to allo-SCT for Ph+ ALL patients without sibling donors. The intergroup trial CALGB 10701 (Alliance) is now testing this strategy in Ph+ ALL patients 〉50 year old, using dasatinib as the BCR/ABL inhibitor. Figure: Disease-free (A, C) and overall (B, D) survival, stratified by minimal residual disease (MRD) at Day +120 and by transplant type. (A, B) MRD ≤0.001 (major molecular response) vs. 〉0.001 at day +120 for patients undergoing autologous-stem cell transplant (SCT); (C, D) allogeneic (allo) vs. autologous (auto) SCT. Figure:. Disease-free (A, C) and overall (B, D) survival, stratified by minimal residual disease (MRD) at Day +120 and by transplant type. (A, B) MRD ≤0.001 (major molecular response) vs. 〉0.001 at day +120 for patients undergoing autologous-stem cell transplant (SCT); (C, D) allogeneic (allo) vs. autologous (auto) SCT. Disclosures: Wetzler: BMS: Research Funding; Novartis: Research Funding. Off Label Use: Dasatinib is off label but in a clinical trial. 615A Oral Session 1 (3 abstracts) Acute promyelocytic leukemia 622A Oral Session 1 (3 abstracts) Autologous and Allogeneic Transplantatin CLL - Biology and Pathophysiology, excluding Therapy: Cell Signaling Leukemias - Biology, Cytogenetics and Molecular Markers in Diagnosis and Prognosis: Chronic Lymphoid and Myeloid Leukemias 111. Hemoglobinopathies, excluding Thalassemia IV
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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