Effect of TKI Maintenance Therapy After Allogeneic Hematopoietic Stem Cell Transplantation on Recurrence of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia p190 and p210 Transcripts: A Multicentre Study.

Abstract

Objective: To analyze the impact of tyrosine kinase inhibitor (TKI) maintenance therapy following allogeneic hematopoietic stem cell transplantation (HSCT) in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL) on recurrence rates and prognosis for the 2 transcripts, p190 and p210.

Methods: We conducted a retrospective analysis of clinical data from 58 patients diagnosed with Ph + ALL who underwent HSCT. All patients received TKI maintenance therapy following hematopoietic reconstruction post-transplantation. We compared the clinical characteristics and prognostic differences between 2 transcript types: p190 (n = 43) and p210 (n = 15).

Result: In terms of clinical characteristics, no significant differences were observed between patients with the 2 transcripts. Multivariate analysis revealed that the T3151 mutation (HR = 5.021, 95% CI [1.129-22.3], P = .034) was an independent risk factor for relapse-free survival (RFS) post-transplantation. Additionally, TKI maintenance therapy for over 1 year was identified as a protective factor for RFS (HR = 0.315, 95% CI [0.115-0.86], P = .025). The median RFS was 89.4 months for the p190 group compared to 59.1 months for the p210 group, which was statistically significant (P = .031). In the subgroup with more than 1 year of TKI maintenance therapy, the median RFS times for p190 and p210 were 95.3 and 90.5 months, respectively, with no statistically significant difference in RFS (P = .080).

Conclusion: The p190 group demonstrated longer RFS compared to the p210 group. However, with early HSCT following induction remission and long-term TKI maintenance therapy post-transplant, the poor prognosis associated with p210 could be mitigated, leading to a trend towards equivalence in outcomes between the 2 transcripts.