Impact of timely BCR-ABL1 monitoring before allogeneic stem cell transplantation among patients with BCR-ABL1-positive B-acute lymphoblastic leukemia
Siew Lian Chong1, Asral Wirda Ahmad Asnawi1,2, Tze Shin Leong3, Jenq Tzong Tan4, Kian Boon Law5, Siong Leng Hon6, Rui Jeat Fann1,7, Sen Mui Tan1
1Department of Haematology, Hospital Ampang, Selangor, 2Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, 3Department of Haematology, Hospital Umum Sarawak, Kuching, 4Department of Medicine, Hospital Taiping, Taiping, 5Institute for Clinical Research, National Institutes of Health (NIH), Shah Alam, 6Department of Medicine, Hospital Melaka, Melaka, 7Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
Correspondence to: Asral Wirda Ahmad Asnawi, M.D., Ph.D.
Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, 71800 Nilai, Negeri Sembilan, Malaysia
E-mail: wirda@usim.edu.my
Published online: August 30, 2021.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: With the emergence of tyrosine kinase inhibitors and the incorporation of stringent measurable residual disease (MRD) monitoring, risk stratification for BCR-ABL1-positive acute lymphoblastic leukemia (ALL) patients has changed significantly. However, whether this monitoring can replace conventional risk factors in determining whether patients need allogeneic stem cell transplantation is still unclear. This study aimed to determine the impact of BCR-ABL1 monitoring on the outcome of patients with BCR-ABL1-positive ALL after allogeneic stem cell transplantation.
Methods: We retrospectively analyzed the survival outcome of patients with BCR-ABL1-positive ALL based on the quantification of BCR-ABL1 at 3 timepoints: the end of induction (timepoint 1), post-consolidation week 16 (timepoint 2), and the end of treatment for patients who were either transplant-eligible or non-transplant eligible (timepoint 3).
Results: From 2006 to 2018, a total of 96 patients newly diagnosed with BCR-ABL1-positive ALL were treated with chemotherapy and tyrosine kinase inhibitors. Thirty-eight (41.3%) patients achieved complete remission, and 33 patients underwent allogeneic stem cell transplantation. Our data showed that pre-transplant MRD monitoring by real-time quantitative polymerase chain reaction had the highest correlation with survival in patients with BCR-ABL1-positive ALL, especially for those who underwent allogeneic stem cell transplantation.
Conclusion: Patients without MRD pre-transplantation had superior survival compared with those who had MRD, and they had excellent long-term outcomes after allogeneic stem cell transplantation.
Keywords: ALL, BCR-ABL1, Philadelphia, Survival, TKI


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