Autologous transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia achieves outcomes similar to allogeneic transplantation: results of CALGB Study 10001 (Alliance)

Abstract

Allogeneic stem cell transplantation is the standard approach to Philadelphia chromosome positive acute lymphoblastic leukemia. We hypothesized that imatinib plus sequential chemotherapy will result in significant leukemia cell cytoreduction in patients with Philadelphia chromosome positive acute lymphoblastic leukemia, allowing collection of normal hematopoietic stem cells uncontaminated by residual BCR/ABL1(+) lymphoblasts and thus reduce the likelihood of relapse after autologous stem cell transplantation for patients under 60 years of age without sibling donors. We enrolled 58 patients; 19 underwent autologous and 15 underwent allogeneic stem cell transplantation on study. Imatinib plus sequential chemotherapy resulted in reverse-transcriptase polymerase chain reaction-negative stem cells in 9 patients and remained minimally positive in 4 (6 were not evaluable). Overall survival (median 6.0 years vs. not reached) and disease-free survival (median 3.5 vs. 4.1 years) were similar between those who underwent autologous and those who underwent allogeneic stem cell transplantation. We conclude that autologous stem cell transplantation represents a safe and effective alternative for allogeneic stem cell transplantation in Philadelphia chromosome positive acute lymphoblastic leukemia patients without sibling donors (clinicaltrials.gov identifier:00039377).

Trial registration: ClinicalTrials.gov NCT00039377.

Figures

Figure 1.

Disease-free (A) and overall survival (B) stratified by BCR-ABL status of the peripheral blood stem cell collection measured by Q-RT-PCR. CMR: complete molecular response; DFS: disease-free survival; MMR: major molecular response.

Figure 2.

Disease-free (A) and overall (B) survival, stratified by minimal residual disease (MRD) at Day +120 following autologous stem cell transplant (SCT); MRD ≤0.001 (major molecular response) versus >0.001 (lack of major molecular response).

Figure 3.

Disease-free (A), overall survival (B) and cumulative incidence of failure (CIF) (C) stratified by transplant type; autologous (auto) stem cell transplant (SCT) versus allogeneic (allo) SCT.