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Ph+ ALL patients in first complete remission have similar survival after reduced intensity and myeloablative allogeneic transplantation: Impact of tyrosine kinase inhibitor and minimal residual disease

Identifieur interne : 004558 ( Main/Exploration ); précédent : 004557; suivant : 004559

Ph+ ALL patients in first complete remission have similar survival after reduced intensity and myeloablative allogeneic transplantation: Impact of tyrosine kinase inhibitor and minimal residual disease

Auteurs : Veronika Bachanova [États-Unis] ; David I. Marks [Royaume-Uni] ; Mei-Jie Zhang [États-Unis] ; Hailin Wang [États-Unis] ; Marcos De Lima [États-Unis] ; Mahmoud D. Aljurf [Arabie saoudite] ; Martha Arellano [États-Unis] ; Andrew S. Artz [États-Unis] ; Ulrike Bacher [Allemagne] ; Jean-Yves Cahn [France] ; Yi-Bin Chen [États-Unis] ; Edward A. Copelan [États-Unis] ; William R. Drobyski [États-Unis] ; Robert Peter Gale [Royaume-Uni] ; John P. Greer [États-Unis] ; Vikas Gupta [Canada] ; Gregory A. Hale [États-Unis] ; Partow Kebriaei [États-Unis] ; Hillard M. Lazarus [États-Unis] ; Ian D. Lewis [Australie] ; Victor A. Lewis [Canada] ; Jane L. Liesveld [États-Unis] ; Mark R. Litzow [États-Unis] ; Alison W. Loren [États-Unis] ; Alan M. Miller [États-Unis] ; Maxim Norkin [États-Unis] ; Betul Oran [États-Unis] ; Joseph Pidala [États-Unis] ; Jacob M. Rowe [Israël] ; Bipin N. Savani [États-Unis] ; Wael Saber [États-Unis] ; Ravi Vij [États-Unis] ; Edmund K. Waller [États-Unis] ; Peter H. Wiernik [États-Unis] ; Daniel J. Weisdorf [États-Unis]

Source :

RBID : PMC:3951192

Descripteurs français

English descriptors

Abstract

The efficacy of reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) for Ph+ acute lymphoblastic leukemia (ALL) is uncertain. We analyzed 197 adults with Ph+ ALL in first complete remission; 67 patients receiving RIC were matched with 130 receiving myeloablative conditioning (MAC) for age, donor type, and HCT year. Over 75% received pre-HCT tyrosine kinase inhibitors (TKI), mostly imatinib; 39% (RIC) and 49% (MAC) were MRDneg pre-HCT. At a median 4.5 years follow-up, 1-year transplant-related mortality (TRM) was lower in RIC (13%) than MAC (36%;p=0.001) while the 3-year relapse rate was 49% in RIC and 28% in MAC (p=0.058). Overall survival was similar (RIC 39% [95% CI:27–52] vs. 35% [95% CI:270–44];p=0.62). Patients MRDpos pre-HCT had higher risk of relapse with RIC versus MAC (HR 1.97;p=0.026). However, patients receiving pre-HCT TKI in combination with MRD negativity pre-RIC HCT had superior OS (55%) compared to a similar MRDneg population after MAC (33%; p=0.0042). In multivariate analysis, RIC lowered TRM (HR 0.6; p=0.057), but absence of pre-HCT TKI (HR 1.88;p=0.018), RIC (HR 1.891;p=0.054) and pre-HCT MRDpos (HR 1.6; p=0.070) increased relapse risk. RIC is a valid alternative strategy for Ph+ ALL patients ineligible for MAC and MRDneg status is preferred pre-HCT.


Url:
DOI: 10.1038/leu.2013.253
PubMed: 23989431
PubMed Central: 3951192


Affiliations:


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Le document en format XML

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<name sortKey="Bachanova, Veronika" sort="Bachanova, Veronika" uniqKey="Bachanova V" first="Veronika" last="Bachanova">Veronika Bachanova</name>
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<nlm:aff id="A1">Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN</nlm:aff>
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<name sortKey="Zhang, Mei Jie" sort="Zhang, Mei Jie" uniqKey="Zhang M" first="Mei-Jie" last="Zhang">Mei-Jie Zhang</name>
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<name sortKey="Wang, Hailin" sort="Wang, Hailin" uniqKey="Wang H" first="Hailin" last="Wang">Hailin Wang</name>
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<name sortKey="Aljurf, Mahmoud D" sort="Aljurf, Mahmoud D" uniqKey="Aljurf M" first="Mahmoud D." last="Aljurf">Mahmoud D. Aljurf</name>
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<name sortKey="Arellano, Martha" sort="Arellano, Martha" uniqKey="Arellano M" first="Martha" last="Arellano">Martha Arellano</name>
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<name sortKey="Artz, Andrew S" sort="Artz, Andrew S" uniqKey="Artz A" first="Andrew S." last="Artz">Andrew S. Artz</name>
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<region type="state">Illinois</region>
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<name sortKey="Bacher, Ulrike" sort="Bacher, Ulrike" uniqKey="Bacher U" first="Ulrike" last="Bacher">Ulrike Bacher</name>
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<name sortKey="Chen, Yi Bin" sort="Chen, Yi Bin" uniqKey="Chen Y" first="Yi-Bin" last="Chen">Yi-Bin Chen</name>
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<region type="state">Caroline du Nord</region>
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<wicri:cityArea>Levine Cancer Institute, Carolinas HealthCare System, Charlotte</wicri:cityArea>
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<name sortKey="Drobyski, William R" sort="Drobyski, William R" uniqKey="Drobyski W" first="William R." last="Drobyski">William R. Drobyski</name>
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<name sortKey="Gale, Robert Peter" sort="Gale, Robert Peter" uniqKey="Gale R" first="Robert Peter" last="Gale">Robert Peter Gale</name>
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<name sortKey="Greer, John P" sort="Greer, John P" uniqKey="Greer J" first="John P" last="Greer">John P. Greer</name>
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<region type="state">Tennessee</region>
</placeName>
<wicri:cityArea>Vanderbilt University Medical Center, Nashville</wicri:cityArea>
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<name sortKey="Gupta, Vikas" sort="Gupta, Vikas" uniqKey="Gupta V" first="Vikas" last="Gupta">Vikas Gupta</name>
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<nlm:aff id="A15">Princess Margaret Hospital, Toronto, ON, CANADA</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Canada</country>
<wicri:regionArea>Princess Margaret Hospital, Toronto, ON</wicri:regionArea>
<wicri:noRegion>ON</wicri:noRegion>
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<name sortKey="Hale, Gregory A" sort="Hale, Gregory A" uniqKey="Hale G" first="Gregory A." last="Hale">Gregory A. Hale</name>
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<nlm:aff id="A16">All Children’s Hospital, St. Petersburg, FL</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Floride</region>
</placeName>
<wicri:cityArea>All Children’s Hospital, St. Petersburg</wicri:cityArea>
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<name sortKey="Kebriaei, Partow" sort="Kebriaei, Partow" uniqKey="Kebriaei P" first="Partow" last="Kebriaei">Partow Kebriaei</name>
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<nlm:aff id="A17">Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX</nlm:aff>
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<placeName>
<region type="state">Texas</region>
</placeName>
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<name sortKey="Lazarus, Hillard M" sort="Lazarus, Hillard M" uniqKey="Lazarus H" first="Hillard M." last="Lazarus">Hillard M. Lazarus</name>
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<nlm:aff id="A4">Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH</nlm:aff>
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<region type="state">Ohio</region>
</placeName>
<wicri:cityArea>Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland</wicri:cityArea>
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<name sortKey="Lewis, Ian D" sort="Lewis, Ian D" uniqKey="Lewis I" first="Ian D." last="Lewis">Ian D. Lewis</name>
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<nlm:aff id="A18">Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital/SA Pathology, Adelaide, AUSTRALIA</nlm:aff>
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<name sortKey="Lewis, Victor A" sort="Lewis, Victor A" uniqKey="Lewis V" first="Victor A." last="Lewis">Victor A. Lewis</name>
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<name sortKey="Liesveld, Jane L" sort="Liesveld, Jane L" uniqKey="Liesveld J" first="Jane L." last="Liesveld">Jane L. Liesveld</name>
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<nlm:aff id="A20">Strong Memorial Hospital, University of Rochester Medical Center; Rochester, NY</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<region type="state">État de New York</region>
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<wicri:cityArea>Strong Memorial Hospital, University of Rochester Medical Center; Rochester</wicri:cityArea>
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<name sortKey="Litzow, Mark R" sort="Litzow, Mark R" uniqKey="Litzow M" first="Mark R." last="Litzow">Mark R. Litzow</name>
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<nlm:aff id="A21">Hematology and Internal Medicine, Mayo Clinic Rochester, Rochester, MN</nlm:aff>
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<region type="state">Minnesota</region>
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</affiliation>
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<author>
<name sortKey="Loren, Alison W" sort="Loren, Alison W" uniqKey="Loren A" first="Alison W." last="Loren">Alison W. Loren</name>
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<nlm:aff id="A22">Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA</nlm:aff>
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<region type="state">Pennsylvanie</region>
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<wicri:cityArea>Perelman School of Medicine at the University of Pennsylvania, Philadelphia</wicri:cityArea>
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<name sortKey="Miller, Alan M" sort="Miller, Alan M" uniqKey="Miller A" first="Alan M." last="Miller">Alan M. Miller</name>
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<nlm:aff id="A23">Baylor University Medical Center, Dallas, TX</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<region type="state">Texas</region>
</placeName>
<wicri:cityArea>Baylor University Medical Center, Dallas</wicri:cityArea>
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<author>
<name sortKey="Norkin, Maxim" sort="Norkin, Maxim" uniqKey="Norkin M" first="Maxim" last="Norkin">Maxim Norkin</name>
<affiliation wicri:level="2">
<nlm:aff id="A24">Shands HealthCare and University of Florida, Gainesville, FL</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<region type="state">Floride</region>
</placeName>
<wicri:cityArea>Shands HealthCare and University of Florida, Gainesville</wicri:cityArea>
</affiliation>
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<author>
<name sortKey="Oran, Betul" sort="Oran, Betul" uniqKey="Oran B" first="Betul" last="Oran">Betul Oran</name>
<affiliation wicri:level="2">
<nlm:aff id="A17">Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Texas</region>
</placeName>
<wicri:cityArea>Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Pidala, Joseph" sort="Pidala, Joseph" uniqKey="Pidala J" first="Joseph" last="Pidala">Joseph Pidala</name>
<affiliation wicri:level="2">
<nlm:aff id="A25">Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Floride</region>
</placeName>
<wicri:cityArea>Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Rowe, Jacob M" sort="Rowe, Jacob M" uniqKey="Rowe J" first="Jacob M." last="Rowe">Jacob M. Rowe</name>
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<nlm:aff id="A26">Department of Hematology, Rambam Medical Center, Haifa, ISRAEL</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Israël</country>
<wicri:regionArea>Department of Hematology, Rambam Medical Center, Haifa</wicri:regionArea>
<wicri:noRegion>Haifa</wicri:noRegion>
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<author>
<name sortKey="Savani, Bipin N" sort="Savani, Bipin N" uniqKey="Savani B" first="Bipin N." last="Savani">Bipin N. Savani</name>
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<nlm:aff id="A14">Vanderbilt University Medical Center, Nashville, TN</nlm:aff>
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<placeName>
<region type="state">Tennessee</region>
</placeName>
<wicri:cityArea>Vanderbilt University Medical Center, Nashville</wicri:cityArea>
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<author>
<name sortKey="Saber, Wael" sort="Saber, Wael" uniqKey="Saber W" first="Wael" last="Saber">Wael Saber</name>
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<nlm:aff id="A3">Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Wisconsin</region>
</placeName>
<wicri:cityArea>Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Vij, Ravi" sort="Vij, Ravi" uniqKey="Vij R" first="Ravi" last="Vij">Ravi Vij</name>
<affiliation wicri:level="2">
<nlm:aff id="A27">Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Missouri (État)</region>
</placeName>
<wicri:cityArea>Barnes Jewish Hospital, Washington University School of Medicine, St. Louis</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Waller, Edmund K" sort="Waller, Edmund K" uniqKey="Waller E" first="Edmund K." last="Waller">Edmund K. Waller</name>
<affiliation wicri:level="2">
<nlm:aff id="A28">Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, GA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Géorgie (États-Unis)</region>
</placeName>
<wicri:cityArea>Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Wiernik, Peter H" sort="Wiernik, Peter H" uniqKey="Wiernik P" first="Peter H." last="Wiernik">Peter H. Wiernik</name>
<affiliation wicri:level="2">
<nlm:aff id="A29">Our Lady of Mercy Medical Center, Bronx, NY</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Our Lady of Mercy Medical Center, Bronx</wicri:cityArea>
</affiliation>
</author>
<author>
<name sortKey="Weisdorf, Daniel J" sort="Weisdorf, Daniel J" uniqKey="Weisdorf D" first="Daniel J." last="Weisdorf">Daniel J. Weisdorf</name>
<affiliation wicri:level="2">
<nlm:aff id="A1">Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName>
<region type="state">Minnesota</region>
</placeName>
<wicri:cityArea>Blood and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis</wicri:cityArea>
</affiliation>
</author>
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<title xml:lang="en" level="a" type="main">Ph+ ALL patients in first complete remission have similar survival after reduced intensity and myeloablative allogeneic transplantation: Impact of tyrosine kinase inhibitor and minimal residual disease</title>
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<region type="state">Illinois</region>
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<nlm:aff id="A12">Medical College of Wisconsin, Milwaukee, WI</nlm:aff>
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<region type="state">Wisconsin</region>
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<wicri:cityArea>Medical College of Wisconsin, Milwaukee</wicri:cityArea>
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<settlement type="city">Londres</settlement>
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<region type="state">Tennessee</region>
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<region type="state">Floride</region>
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<region type="state">Texas</region>
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<region type="state">Ohio</region>
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<wicri:cityArea>Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland</wicri:cityArea>
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<region type="state">État de New York</region>
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<region type="state">Minnesota</region>
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<name sortKey="Loren, Alison W" sort="Loren, Alison W" uniqKey="Loren A" first="Alison W." last="Loren">Alison W. Loren</name>
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<region type="state">Pennsylvanie</region>
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<name sortKey="Miller, Alan M" sort="Miller, Alan M" uniqKey="Miller A" first="Alan M." last="Miller">Alan M. Miller</name>
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<nlm:aff id="A23">Baylor University Medical Center, Dallas, TX</nlm:aff>
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<region type="state">Texas</region>
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<wicri:cityArea>Baylor University Medical Center, Dallas</wicri:cityArea>
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<name sortKey="Norkin, Maxim" sort="Norkin, Maxim" uniqKey="Norkin M" first="Maxim" last="Norkin">Maxim Norkin</name>
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<nlm:aff id="A24">Shands HealthCare and University of Florida, Gainesville, FL</nlm:aff>
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<region type="state">Floride</region>
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<wicri:cityArea>Shands HealthCare and University of Florida, Gainesville</wicri:cityArea>
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<name sortKey="Oran, Betul" sort="Oran, Betul" uniqKey="Oran B" first="Betul" last="Oran">Betul Oran</name>
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<nlm:aff id="A17">Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<region type="state">Texas</region>
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<name sortKey="Pidala, Joseph" sort="Pidala, Joseph" uniqKey="Pidala J" first="Joseph" last="Pidala">Joseph Pidala</name>
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<nlm:aff id="A25">Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL</nlm:aff>
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<placeName>
<region type="state">Floride</region>
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<wicri:cityArea>Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa</wicri:cityArea>
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<name sortKey="Rowe, Jacob M" sort="Rowe, Jacob M" uniqKey="Rowe J" first="Jacob M." last="Rowe">Jacob M. Rowe</name>
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<nlm:aff id="A26">Department of Hematology, Rambam Medical Center, Haifa, ISRAEL</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Israël</country>
<wicri:regionArea>Department of Hematology, Rambam Medical Center, Haifa</wicri:regionArea>
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<name sortKey="Savani, Bipin N" sort="Savani, Bipin N" uniqKey="Savani B" first="Bipin N." last="Savani">Bipin N. Savani</name>
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<nlm:aff id="A14">Vanderbilt University Medical Center, Nashville, TN</nlm:aff>
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<region type="state">Tennessee</region>
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<nlm:aff id="A3">Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI</nlm:aff>
<country xml:lang="fr">États-Unis</country>
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<region type="state">Wisconsin</region>
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<region type="state">Missouri (État)</region>
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<nlm:aff id="A28">Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, GA</nlm:aff>
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<name sortKey="Wiernik, Peter H" sort="Wiernik, Peter H" uniqKey="Wiernik P" first="Peter H." last="Wiernik">Peter H. Wiernik</name>
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<nlm:aff id="A29">Our Lady of Mercy Medical Center, Bronx, NY</nlm:aff>
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<region type="state">État de New York</region>
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<region type="state">Minnesota</region>
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<title level="j">Leukemia</title>
<idno type="ISSN">0887-6924</idno>
<idno type="eISSN">1476-5551</idno>
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<date when="2013">2013</date>
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<term>Adult</term>
<term>Animals</term>
<term>Bone Marrow Transplantation</term>
<term>Female</term>
<term>Guinea Pigs</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Neoplasm, Residual</term>
<term>Philadelphia Chromosome</term>
<term>Precursor Cell Lymphoblastic Leukemia-Lymphoma (pathology)</term>
<term>Precursor Cell Lymphoblastic Leukemia-Lymphoma (surgery)</term>
<term>Protein-Tyrosine Kinases (antagonists & inhibitors)</term>
<term>Remission Induction</term>
<term>Survival Rate</term>
<term>Transplantation Conditioning</term>
<term>Transplantation, Homologous</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Animaux</term>
<term>Chromosome Philadelphie</term>
<term>Cochons d'Inde</term>
<term>Conditionnement pour greffe</term>
<term>Femelle</term>
<term>Humains</term>
<term>Induction de rémission</term>
<term>Jeune adulte</term>
<term>Leucémie-lymphome lymphoblastique à précurseurs B et T ()</term>
<term>Leucémie-lymphome lymphoblastique à précurseurs B et T (anatomopathologie)</term>
<term>Maladie résiduelle</term>
<term>Mâle</term>
<term>Protein-tyrosine kinases (antagonistes et inhibiteurs)</term>
<term>Taux de survie</term>
<term>Transplantation de moelle osseuse</term>
<term>Transplantation homologue</term>
</keywords>
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<term>Protein-Tyrosine Kinases</term>
</keywords>
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<term>Leucémie-lymphome lymphoblastique à précurseurs B et T</term>
</keywords>
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<term>Protein-tyrosine kinases</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en">
<term>Precursor Cell Lymphoblastic Leukemia-Lymphoma</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en">
<term>Precursor Cell Lymphoblastic Leukemia-Lymphoma</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Adult</term>
<term>Animals</term>
<term>Bone Marrow Transplantation</term>
<term>Female</term>
<term>Guinea Pigs</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Neoplasm, Residual</term>
<term>Philadelphia Chromosome</term>
<term>Remission Induction</term>
<term>Survival Rate</term>
<term>Transplantation Conditioning</term>
<term>Transplantation, Homologous</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Animaux</term>
<term>Chromosome Philadelphie</term>
<term>Cochons d'Inde</term>
<term>Conditionnement pour greffe</term>
<term>Femelle</term>
<term>Humains</term>
<term>Induction de rémission</term>
<term>Jeune adulte</term>
<term>Leucémie-lymphome lymphoblastique à précurseurs B et T</term>
<term>Maladie résiduelle</term>
<term>Mâle</term>
<term>Taux de survie</term>
<term>Transplantation de moelle osseuse</term>
<term>Transplantation homologue</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p id="P1">The efficacy of reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) for Ph+ acute lymphoblastic leukemia (ALL) is uncertain. We analyzed 197 adults with Ph+ ALL in first complete remission; 67 patients receiving RIC were matched with 130 receiving myeloablative conditioning (MAC) for age, donor type, and HCT year. Over 75% received pre-HCT tyrosine kinase inhibitors (TKI), mostly imatinib; 39% (RIC) and 49% (MAC) were MRD
<sup>neg</sup>
pre-HCT. At a median 4.5 years follow-up, 1-year transplant-related mortality (TRM) was lower in RIC (13%) than MAC (36%;p=0.001) while the 3-year relapse rate was 49% in RIC and 28% in MAC (p=0.058). Overall survival was similar (RIC 39% [95% CI:27–52] vs. 35% [95% CI:270–44];p=0.62). Patients MRD
<sup>pos</sup>
pre-HCT had higher risk of relapse with RIC versus MAC (HR 1.97;p=0.026). However, patients receiving pre-HCT TKI in combination with MRD negativity pre-RIC HCT had superior OS (55%) compared to a similar MRD
<sup>neg</sup>
population after MAC (33%; p=0.0042). In multivariate analysis, RIC lowered TRM (HR 0.6; p=0.057), but absence of pre-HCT TKI (HR 1.88;p=0.018), RIC (HR 1.891;p=0.054) and pre-HCT MRD
<sup>pos</sup>
(HR 1.6; p=0.070) increased relapse risk. RIC is a valid alternative strategy for Ph+ ALL patients ineligible for MAC and MRD
<sup>neg</sup>
status is preferred pre-HCT.</p>
</div>
</front>
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<name sortKey="Pavlova, A" uniqKey="Pavlova A">A Pavlova</name>
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<name sortKey="Wunderle, L" uniqKey="Wunderle L">L Wunderle</name>
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<name sortKey="Oldenburg, J" uniqKey="Oldenburg J">J Oldenburg</name>
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</author>
<author>
<name sortKey="Ho, V" uniqKey="Ho V">V Ho</name>
</author>
<author>
<name sortKey="Kan, F" uniqKey="Kan F">F Kan</name>
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<author>
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<name sortKey="Vignetti, M" uniqKey="Vignetti M">M Vignetti</name>
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<author>
<name sortKey="Kantarjian, Hm" uniqKey="Kantarjian H">HM Kantarjian</name>
</author>
<author>
<name sortKey="Le Coutre, Pd" uniqKey="Le Coutre P">PD le Coutre</name>
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<author>
<name sortKey="Baccarani, M" uniqKey="Baccarani M">M Baccarani</name>
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<author>
<name sortKey="Hochhaus, A" uniqKey="Hochhaus A">A Hochhaus</name>
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<analytic>
<author>
<name sortKey="Grupp, Sa" uniqKey="Grupp S">SA Grupp</name>
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<name sortKey="Kalos, M" uniqKey="Kalos M">M Kalos</name>
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<name sortKey="Aplenc, R" uniqKey="Aplenc R">R Aplenc</name>
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<author>
<name sortKey="Oldani, E" uniqKey="Oldani E">E Oldani</name>
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<author>
<name sortKey="Intermesoli, T" uniqKey="Intermesoli T">T Intermesoli</name>
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