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Tracy SI, Cao Q, Bachan B, Meredith M, Oseth L, Weisdorf D, Brunstein C, Hirsch B, Bachanova V. Ph-like gene alterations and complex chromosomal abnormalities are frequent in patients with acute lymphoblastic leukemia experiencing relapse after allogeneic hematopoietic cell transplantation. Eur J Haematol 2022; 109:406-408. [PMID: 35700331 PMCID: PMC9474703 DOI: 10.1111/ejh.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
The new aspect of our work is to reveal that Ph-like alterations are common among patients with Ph-ALL experiencing relapse after hematopoietic cell transplantation (HCT), despite acquisition of MRD-negative complete responses prior to transplant. This is also the central finding of our work. Therefore, the anticipated benefits of HCT appear diminished among this patient subset; such patients may be better served with efforts to further increase MRD depth prior to HCT, or alternative therapies.
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Affiliation(s)
- Sean I. Tracy
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Qing Cao
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Ben Bachan
- University of Minnesota, Minneapolis, MN
| | - Matthew Meredith
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - LeAnn Oseth
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Daniel Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Claudio Brunstein
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Betsy Hirsch
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
| | - Veronika Bachanova
- Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN
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Abdel-Rahman ZH, Heckman MG, Anagnostou T, White LJ, Kloft-Nelson SM, Knudson RA, Alkhateeb HB, Sproat LZ, Khera N, Murthy HS, Ayala E, Hogan WJ, Roy V, Peterson JF, Kharfan-Dabaja MA, Ketterling RP, Litzow MR, Baughn LB, Patnaik M, Greipp PT, Foran JM. Identification of adult Philadelphia-like acute lymphoblastic leukemia using a FISH-based algorithm distinguishes prognostic groups and outcomes. Blood Cancer J 2021; 11:156. [PMID: 34548472 PMCID: PMC8455651 DOI: 10.1038/s41408-021-00538-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Zaid H Abdel-Rahman
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Theodora Anagnostou
- Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Launia J White
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Sara M Kloft-Nelson
- Cytogenetics Core Laboratory, Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | - Ryan A Knudson
- Cytogenetics Core Laboratory, Medical Genome Facility, Mayo Clinic, Rochester, MN, USA
| | | | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Nandita Khera
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Vivek Roy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | | | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | | | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA.
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Abdel Rahman ZH, Heckman MG, Miller K, Alkhateeb H, Patnaik MS, Sproat LZ, Jiang L, Roy V, Murthy HS, Ayala E, Hogan WJ, Greipp PT, Kharfan-Dabaja MA, Litzow MR, Foran JM. Impact of Novel Targeted Therapies and Cytogenetic Risk Groups on Outcome After Allogeneic Transplantation for Adult ALL. Transplant Cell Ther 2020; 27:165.e1-165.e11. [PMID: 33830026 DOI: 10.1016/j.jtct.2020.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Abstract
Novel high-risk groups have recently been identified in adult acute lymphoblastic leukemia (ALL), including Philadelphia-like, therapy-related, and measurable residual disease after induction therapy. Furthermore, modern targeted therapies have recently been incorporated into ALL management; rituximab for CD20-positive and blinatumomab for measurable residual disease after induction therapy or relapsed or refractory disease. Allogeneic hematopoietic cell transplantation (allo-HCT) is recommended as consolidation therapy for high-risk ALL; however, its relative benefit for these high-risk groups and after novel therapies is unclear. We performed an analysis of posttransplantation outcomes in a cohort of 261 consecutive patients who underwent allo-HCT for ALL at the 3-site Mayo Clinic Cancer Center (January 1, 2008-December 31, 2018). With a median (range) follow-up of 22.4 months (0.5-135.0), the 100-day and 5-year cumulative incidences of nonrelapse mortality rates were 6.5% and 26.7%, respectively. The 5-year cumulative incidences of relapse and death were 22.6% and 46.2%, respectively. The 1-year estimate of the composite endpoint of graft-versus-host disease/relapse-free survival was 39.3%. We observed no associations of novel high-risk groups or modern targeted therapies with overall survival, nonrelapse mortality, or relapse in multivariable analysis. An increased risk of relapse was observed with T-ALL (hazard ratio, 2.16; 95% confidence interval, 1.14-4.09; P = .02) and hypodiploidy/near-triploidy (hazard ratio, 2.84; 95% confidence interval, 1.06-7.62; P = .04). Our analysis suggests that novel high-risk groups derive a similar benefit from allo-HCT as traditional high-risk adult ALL and that novel targeted therapies do not seem to independently predict for posttransplantation outcomes. It also calls for further exploration of maintenance strategies after Allo-HCT to prevent relapse in high-risk subgroups.
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Affiliation(s)
- Zaid H Abdel Rahman
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Kevin Miller
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Lisa Z Sproat
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Liuyan Jiang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Vivek Roy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Hemant S Murthy
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | | | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - James M Foran
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida.
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