Achieving Molecular Remission before Allogeneic Stem Cell Transplantation in Adult Patients with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia: Impact on Relapse and Long-Term Outcome

作者：Lussana Federico^*; Intermesoli Tamara; Gianni Francesca; Boschini Cristina; Masciulli Arianna; Spinelli Orietta; Oldani Elena; Tosi Manuela; Grassi Anna; Parolini Margherita; Audisio Ernesta; Cattaneo Chiara; Raimondi Roberto; Angelucci Emanuele; Cavattoni Irene Maria; Scattolin Anna Maria; Cortelezzi Agostino; Mannelli Francesco; Ciceri Fabio; Mattei Daniele; Borlenghi Erika; Terruzzi Elisabetta; Romani Claudio; Bassan Renato; Rambaldi Alessandro

来源：Biology of Blood and Marrow Transplantation, 2016, 22(11): 1983-1987.

DOI：10.1016/j.bbmt.2016.07.021

• Acute lymphoblastic leukemia
• Allogeneic transplantation
• Minimal residual disease (MRD)

Allogeneic stem cell transplantation (alloHSCT) in first complete remission (CR1) remains the consolidation therapy of choice in Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL). The prognostic value of measurable levels of minimal residual disease (MRD) at time of conditioning is a matter of debate. We analyzed the predictive relevance of MRD levels before transplantation on the clinical outcome of Ph+ ALL patients treated with chemotherapy and imatinib in 2 consecutive prospective clinical trials. MRD evaluation before transplantation was available for 65 of the 73 patients who underwent an alloHSCT in CR1. A complete or major molecular response at time of conditioning was achieved in 24 patients (37%), whereas 41 (63%) remained carriers of any other positive MRD level in the bone marrow. MRD negativity at time of conditioning was associated with a significant benefit in terms of risk of relapse at 5 years, with a relapse incidence of 8% compared with 39% for patients with MRD positivity (P=.007). However, thanks to the post-transplantation use of tyrosine kinase inhibitors (TKIs), disease-free survival was 58% versus 41% (P=.17) and overall survival was 58% versus 49% (P=.55) in MRD-negative compared with MRD-positive patients, respectively. The cumulative incidence of nonrelapse mortality was similar in the 2 groups. Achieving a complete molecular remission before transplantation reduces the risk of leukemia relapse even though TKIs may still rescue some patients relapsing after transplantation.

• 出版日期2016-11