Comparison of Clinical Outcomes between P190 and P210 Trans-cripts in Adult Ph Chromosome Positive Acute Lymphoblastic Leukemia in the New Era of TKI / 中国实验血液学杂志

ABSTRACT

<p><b>OBJECTIVE</b>To explore the differences of clinical characteristics and outcome between p190 and p210 transcripts in adult Ph chromosome positive acute lymphoblastic leukemia patients in the new era with tyrosine kinase inhibitor (TKI) treatment, so as to provide an insight for improving the prognostic stratification and individualized treatment of the Ph(+) ALL patients.</p><p><b>METHODS</b>The clinical data of 65 patients were analysed retrospectively, these patients were diagnosed as Ph(+) ALL and treated with conventional chemotherapy plus TKI treatment with or without hematopoietic stem cell transplantation (HSCT) from January 2005 to December 2014 in our hospital, then the differences of clinical features and prognosis were compared between the p190 (n = 41) and the p210 group (n = 24).</p><p><b>RESULTS</b>The p190 group had lower platelet count than the p210 group (46.3 × 10(9)/L vs 65 × 10(9)/L) (P = 0.084); the leukemic blast cells in bone marrow at diagnosis was slightly higher in p190 group than that in p210 group (88.4% vs 76.8%) (P = 0.096); the other clinical features, such as sex, age, white blood cells, hemoglobin, leukemic blast cells in peripheral blood, and BCR-ABL/ABL expression level were not significantly different between these two groups. As to the response to treatment, the complete remission rate (CR) after induction therapy was 80% (32/40) and 87% (20/23) respectively in the p190 and p210 group, no significant difference was seen (P = 0.732). The time from induction to the first complete remission (CR1) was not significantly different either (28 days vs 29 days) (P = 0.922). The recurrence rate was 61% (20/33) in the p190 group and 43% (9/21) in the p210 group, but the difference was not significantly different (P = 0.202). However, the duration of remission in p190 group was shorter than that in p210 group, whether from the time of initial diagnosis to relapse (212 days vs 274 days) (P = 0.077) or from the time of CR1 to relapse (146 days vs 242 days) (P = 0.084). For the prognosis, the p190 group presented with a shorter 5 year-survival rate (P = 0.016) as well as event-free survival rate (P = 0.085).</p><p><b>CONCLUSION</b>The p190 group tends to have lower peripheral blood platelet count and higher percentage of leukemic blasts in bone marrow at diagnosis; while the CR rate and the time from induction to CR1 are not significantly different; however, the p190 group is more likely to relapse at a relatively early stage, and the 5 year-survival rate and event-free survival rate are lower in p190 group than that in p210 group, indicating that the patients carrying p190 transcript are probably necessary to receive more intensive therapy such as HSCT as early as possible after achieving CR1, which can promisingly improve the overall prognosis of the Ph(+) ALL patients.</p>