Session: 612. Acute Lymphoblastic Leukemias: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, Biological therapies, ALL, adult, Research, health outcomes research, Clinical Research, Diseases, Therapies, Lymphoid Malignancies, Technology and Procedures, Study Population, Human, Transplantation
Methods: A retrospective chart review of Ph+ ALL treated at PMCC from 2001 to 2019 was undertaken. Patient demographic data, disease characteristics, response, and course, as well as treatment information, were collected and a descriptive summary was presented using counts/proportions and median/IQR or range as appropriate. OS/RFS rates were calculated using the Kaplan-Meier product-limit method, and the impact of covariates of interest were assessed using the Log-rank test.
Results: 158 Ph+ ALL patients were identified since 2001. 56 patients (35.4%) received a transplant in CR1, while 102 (64.6%) did not. All patients received a modified pediatric-inspired regimen typically with imatinib (Table 1). Median follow up was 38 months (range 1 to 229 months). 144/158 patients achieved a CR with first induction (91%). N=6 patients died during induction (3.8%). Overall survival for all patients at 3 and 4 years, was 61.8% (95% CI 53.4-69.1%) and 54.1% (95% CI 45.5-61.9%) respectively. Overall RFS at 3 and 4 years, was 51.7% (95% CI 43.3-59.4%) and 46.3% (95% CI 37.9-54.2%) respectively. When stratified by transplant in CR1, 3-year OS was 49.8% (95% CI 36.1-62.0%) in transplanted patients vs 69.2% (95% CI 49.3-69.9%) in non-transplanted patients; p=0.145 (Figure 1). There was no significant difference in RFS at 3 years in transplanted (46.4% [95% CI 33.0-58.7%]) vs non-transplanted (55% [95% CI 44.2-64.6%]) patients; p=0.89. A 6-month PCR level indicating a molecular 3 log (or deeper) reduction (MR3) in BCR-ABL1 transcripts predicted a statistically significant improved 3-year RFS of 71.4% (95% CI 40.6-88.2%) vs those who had achieved only an MR2 (25% [95% CI 0.9%-66.5%] p=0.037). Overall, 48 patients relapsed. Of these, 13 received blinatumomab +/- a tyrosine kinase inhibitor (TKI) after relapse and 12/13 (92.3%) achieved a second CR, including one patient who had relapsed post-transplant. Of the 12 who achieved a CR2, 5 went on to an allogeneic transplant.
Conclusion: Using a modified pediatric regimen and imatinib, there was no difference in overall survival between transplanted and non-transplanted Ph+ ALL patients, provided that they achieved an MR3 (or deeper) at 6 months. In those who were not transplanted in CR1 and subsequently relapsed, blinatumomab + TKI was a successful salvage regimen.
Disclosures: Schuh: GlycoMimetics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Phebra: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astellas: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees; Teva Pharmaceutical Industries: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees. Yee: F. Hoffmann La Roche: Consultancy, Research Funding; Bristol-Myers Squibb/Celgene: Consultancy; Shattuck Labs: Consultancy; Astex: Research Funding; Takeda: Consultancy; Novartis: Consultancy, Honoraria, Research Funding; Abbvie: Honoraria; TaiHo: Consultancy; Janssen: Research Funding; Treadwell: Research Funding; Forma Therapeutics: Research Funding; Geron: Research Funding; Gilead: Research Funding; Karyopharm: Research Funding; Jazz: Consultancy, Research Funding; GlaxoSmithKline: Consultancy; Pfizer: Consultancy; Astellas: Consultancy. Schimmer: Novartis: Consultancy, Honoraria; Astra Zeneca: Consultancy, Honoraria; Takeda Pharmaceuticals: Consultancy, Honoraria, Research Funding; Otsuka Pharmaceuticals: Consultancy, Honoraria; Jazz: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Research Funding; Medivir AB: Research Funding; UHN: Patents & Royalties: the use of DNT cells to treat AML. Gupta: Novartis: Consultancy, Honoraria; Constellation Pharmaceuticals, Inc., a MorphoSys Company: Consultancy, Honoraria; Pfizer: Consultancy, Other: Participation on a Data Safety or Advisory board; Sierra Oncology: Consultancy; Roche: Other: Participation on a Data Safety or Advisory board; AbbVie: Consultancy, Other: Participation on a Data Safety or Advisory board; BMS Celgene: Consultancy, Honoraria, Other: Participation on a Data Safety or Advisory board. Kim: Paladin: Consultancy, Honoraria, Research Funding; BMS: Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Merck: Consultancy; Sanof: Consultancy, Honoraria.
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