Clinical study of Philadelphia chromosome-positive acute lymphoblastic leukemia

Objective To study the clinical characteristics and therapeutic outcome of Ph+ acute lymphoblastic leukemia (ALL). Methods Thirty previously untreated cases of Ph~+ B-ALL were diagnosed in our institute. The patients were treated with combination chemotherapy of CODP±L regimen, Imatinib (400～600 mg/d) was continuously given to those who couldn’t reach CR. Forteen patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CR, while 16 received consolidation of intensive chemotherapy. Results Thirty (32.6%) of 92 ALL patients were diagnased as Ph+ ALL, with a median age of 25.5 (14—60). Among them Ph+ as the sole anomaly was seen in 16 patients, and Ph+ with additional chromosome abnormalities in 14. Besides the B cell markers, 23 (76.7%) patients had CD34+ and 13(43.3%) CD13+ and/or CD33+. Nineteen of the Ph+ ALL patients underwent molecular analysis; 13(~68.4% ) expressed P190 and 6(31.6%) P210. Increased WBC (30×10~9 /L) was found in 22/30 cases while WBC 100×10~9 /L in 9/30 cases. The chemotherapy complete remission rate was 68.8% in patients with only Ph+ versus 28.6% in those with additional chromosome abnormalities. All seven refractory/relapsed patients reached CR with Inatinib therapy. The total complete remission rate was 73.3% in all Ph~+ ALL patients. The median remission duration was shorter in patients with additional chromosome than in those with only Ph~+ (1 vs 7 months, P0.05), and so was the survival period (7 vs 9 months, P0.05). The remission duration was significantly longer in patients received allo-HSCT than in those received chemotherapy only (8 vs 0.5 month, P0.05), and so was the survival period (12.5 vs 6 months, P0.05).Conclusion Additional chromosome abnormalites negatively affect the prognosis and therapeutic effect of Ph+ ALL patients. Imatinib is effective for the induction therapy of Ph+ ALL . The survival period of patients who received allo-HSCT was obviously longer than those who received chemotherapy only.