Prolonged Survival in Philadelphia Positive Acute Lymphoblastic Leukemia Treated with Autologus Stem Cell Transplantation in the Inhibitor Tyrosine Kinase Era : A Retrospective Study

With tyrosine kinase inhibitors (TKI) containing regimen and without allogenic stem cell transplantation (SCT), some studies showed prolonged survival in Philadelphia positive (Ph+) acute lymphoblastic leukemia (ALL), questioning the place of the allogenic SCT in the TKI era. We retrospectively reported the outcome of 39 patients with ALL Ph+ cured at the Bocage hospital, Dijon, France. The complete remission rate (CR) after induction was 100%, 1 patient died during consolidations. Two patients received an allogenic SCT and died of treatment related toxicity. Thirty six patients were referred to an autologus SCT strategy, in case of collection failure (7 patients) they received prolonged chemotherapy, for all TKI was given until progression or death. In this group the 5 years probability of overall survival and progression free survival are 60% and 53% respectively. Twenty two patients are alive in CR, 13 relapsed, 1 died in CR. Older age and high white blood count at diagnosis are bad prognostic factors. There were no correlation between minimal residual disease and prognosis. Our study showed prolonged survival is possible without allogenic SCT, in the TKI era. Autologus SCT is easily accessible and is associated with a very low mortality. These results should be confirmed by prospective studies including a larger number of patients.