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Candoni A, Chiusolo P, Lazzarotto D, Sartor C, Dargenio M, Chiaretti S, Skert C, Giglio F, Trappolini S, Fracchiolla NS, Medici S, Bresciani P, Cuoghi A, Papayannidis C. Ponatinib as a Prophylactic or Pre-Emptive Strategy to Prevent Cytological Relapse after Allogeneic Stem Cell Transplantation in Patients with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia Transplanted in Complete Cytological Remission. Cancers (Basel) 2024; 16:2108. [PMID: 38893226 PMCID: PMC11171293 DOI: 10.3390/cancers16112108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
The administration of TKIs after Allo-SCT in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL) remains controversial, and the TKI approach (prophylactic, pre-emptive or salvage) is still heterogeneous in transplant centers. In this context, very little is known about the feasibility and safety of third-generation TKIs. In this paper, we analyze the efficacy and safety of ponatinib (PONA) administered after Allo-SCT to prevent cytologic relapse of Ph + ALL. This is a multicenter observational study including 48 patients (pts) with Ph + ALL (median age 49 years) who received PONA after Allo-SCT while in complete cytological remission (cCR); 26 (54%) had positive minimal residual disease (MRD pos) before Allo-SCT. PONA was administered after Allo-SCT prophylactically (starting with MRD neg) in 26 pts or pre-emptively (starting with MRD pos post-SCT and without hematological relapse) in 22 pts. Patients treated prophylactically with PONA started treatment earlier, at a median of 4.3 months (range 1.5-6) after Allo-SCT, than those treated pre-emptively, who started PONA at a median of 7.4 months (range 2-63) after Allo-SCT (p = 0.01). The median starting dose of PONA was 30 mg/day (range 15-45). A dose reduction was required in 10/48 (21%) of cases, but a permanent discontinuation of PONA, due to toxicity, was required in only 5/48 pts (10.5%). No deaths due to PONA-related adverse events (AEs) were reported. The median follow-up time after Allo-SCT was 34 months (range 7.7-118). At the last follow-up, the median duration of PONA therapy was 22 months (range 2-100). The 5-year OS and RFS after Allo-SCT were 92% and 71%, respectively. The 5-year RFS after Allo-SCT of pts who received PONA prophylaxis was 95%, and it was 57% for those who received PONA pre-emptively (log-rank p = 0.02). In conclusion, this multicenter analysis of 48 patients with Ph + ALL undergoing Allo-SCT while in CcR, although with the caution of the retrospective data, supports the feasibility of PONA maintenance strategy after Allo-SCT with a low rate of discontinuations (10.5%) due to PONA-related AE.
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Affiliation(s)
- Anna Candoni
- Section of Haematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41123 Modena, Italy
- Division of Hematology and Stem Cell Transplantation, ASUFC, 33100 Udine, Italy
| | - Patrizia Chiusolo
- Hematology and Stem Cell Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00136 Rome, Italy
| | - Davide Lazzarotto
- Division of Hematology and Stem Cell Transplantation, ASUFC, 33100 Udine, Italy
| | - Chiara Sartor
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, Istituto di Ematologia Seragnoli, 40126 Bologna, Italy
| | - Michelina Dargenio
- Unità Operativa di Ematologia e Trapianto, Ospedale Vito Fazzi, 73100 Lecce, Italy
| | - Sabina Chiaretti
- Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
| | - Cristina Skert
- Hematology Unit, Ospedale Dell’Angelo, Mestre, 30174 Venice, Italy
| | - Fabio Giglio
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Silvia Trappolini
- Hematology Department, University of Ancona, Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | | | - Sara Medici
- Section of Haematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41123 Modena, Italy
| | - Paola Bresciani
- Section of Haematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41123 Modena, Italy
| | - Angela Cuoghi
- Section of Haematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41123 Modena, Italy
| | - Cristina Papayannidis
- IRCCS Azienda Ospedaliero—Universitaria di Bologna, Istituto di Ematologia Seragnoli, 40126 Bologna, Italy
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Ribera JM, Ribera J, Genescà E. EXABS-136-ALL Certain Patients with ALL Still Need a Transplant. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22 Suppl 2:S47-S49. [PMID: 36164226 DOI: 10.1016/s2152-2650(22)00657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Josep-Maria Ribera
- Clinical Hematology Department. ICO-Hospital Germans Trias i Pujol. Josep Carreras Research Institute. Universitat Autònoma de Barcelona, c/Canyet s/n, 08916 Badalona, Barcelona, Spain
| | - Jordi Ribera
- Josep Carreras Research Institute. c/Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain
| | - Eulalia Genescà
- Josep Carreras Research Institute. c/Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain
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