Outcome of Philadelphia Positive Acute Lymphoblastic Leukemia With or Without Allogeneic Stem Cell Transplantation in a Retrospective Study

Philadelphia positive ALL (Ph+ALL) is an aggressive leukemia associated with lower remission rates and poor survival. Current treatment approach for Ph+ALL is chemotherapy along with TKI and CNS directed therapy followed by Allogeneic stem cell transplantation (Allo-SCT). To analyze outcome of Ph+ALL with or without Allo-SCT in the era of universal TKI uses. Retrospectively reviewed medical records of 267 patients who were diagnosed and treated for ALL during study period at our centre. Fifty-one Ph+ALL patients (males=31, females=20) out of a total of 267 ALL patients were eligible for the study. Post induction 48 patients achieved complete remission while 1 died during induction. Forty-six patients received further treatment with TKI+CNS directed therapy and thereafter the consolidation therapy with Allo-SCT (n=16) or chemotherapy+TKI (n=30).Overall mortality was 7/51 (13.9%) (6/16 transplant related mortalities due to GVHD and infections and 1 induction death). Fifteen out of 46 patients (32.6%) had relapse (1/10 relapse after Allo-SCT vs. 14/24 after chemotherapy) on or after consolidation therapy. At a median follow-up of 17.5months (2-58months) of cohort, the median EFS was 22months (95% CI 10.4-33.5months). The estimated 4year EFS and PFS in Allo-SCT versus chemotherapy only group was 36.0 +/- 17.9 versus 27.3 +/- 9.1% (p=0.21) and 75 +/- 21.7 versus 34.1 +/- 10.9% (p=0.02) respectively. Allo-SCT groups has a better progression free survival than chemotherapy group only. Preventing treatment related mortality can further improve outcome after Allo-SCT Ph+ALL.