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EHA 2021 | Survival trends for patients with relapsed Ph+ ALL after allo-HSCT

Ali Bazarbachi, MD, American University of Beirut Medical Center, Beirut, Lebanon, discusses the findings of a study investigating the impacts of relapse after allogeneic hematopoietic cell transplantation (allo-HCT) on survival outcomes in patients with Philadelphia positive (Ph+) acute lymphoblastic leukemia (ALL), highlighting how recent therapeutic advances have improved patient outcomes. Data from 899 patients in the EBMT registry was used in the analysis. The study reported a two-year post-relapse overall survival rate of 45% (95% CI:38-44.9) with the two-year survival rate increasing over time. This interview took place at the virtual European Hematology Association (EHA) Congress 2021.

Transcript (edited for clarity)

The EHA meeting we’ll be presenting trends and predictive factors for outcome of relapsed Philadelphia-positive acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation. So basically, relapsed Philadelphia-positive ALL after allotransplant has historically a dismal prognosis, and treatment in that setting includes reduction or withdrawal of immunosuppression, chemotherapy, tyrosine kinase inhibitors, donor lymphocyte infusion, a second allotransplant, or even palliative care...

The EHA meeting we’ll be presenting trends and predictive factors for outcome of relapsed Philadelphia-positive acute lymphoblastic leukemia after allogeneic hematopoietic cell transplantation. So basically, relapsed Philadelphia-positive ALL after allotransplant has historically a dismal prognosis, and treatment in that setting includes reduction or withdrawal of immunosuppression, chemotherapy, tyrosine kinase inhibitors, donor lymphocyte infusion, a second allotransplant, or even palliative care.

However, more recently, additional therapies were available, including new generation tyrosine kinase inhibitors, monoclonal antibodies, such as blinatumomab and inotuzumab, as well as CAR T-cells. However, very little information is available about the global impact of the current standard of care for relapsed Philadelphia-positive ALL after allo-SCT.

So, within the EBMT Acute Leukemia Working Party, we analyzed 899, almost 900 adult patients with Philadelphia-positive ALL who suffered from hematologic relapse between 2000 and 2019 after allotransplant performed in first complete remission from matched siblings or matched unrelated donors.

The median follow-up for survivors was 56 months. And indeed, what we observed was a steady increase over time, almost doubling, from 27.8% to 54.8% and two years survival for Philadelphia-positive ALL and relapse after transplant. So basically, those who relapsed between 2000 and 2004 had a three-year overall survival from relapse of 27.8%. That increased to 31, 32% between 2005 to 2009; 44%, 2010, 2014; and 54.5, 55% between 2015, 2019.

So, we cannot say any more that these patients have a dismal prognosis. There is great hope even after relapse after allotransplant. And in multivariate analysis, overall survival from relapse was positively affected by an increased time from transplant to relapse, and by the year of relapse. And this progressive improvement in overall survival post-transplant relapse likely reflects the efficacy of post-transplant salvage. And importantly, these large-scale real-world data can serve as a benchmark for future studies in that setting.

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