Allogeneic hematopoietic cell transplantation for acute myeloid leukemia with BCR::ABL1 fusion

Shohei Mizuno; Akiyoshi Takami; Koji Kawamura; Kaito Harada; Masuko Masayoshi; Shingo Yano; Ayumu Ito; Yukiyasu Ozawa; Fumihiko Ouchi; Takashi Ashida; Yuichiro Nawa; Tatsuo Ichinohe; Takahiro Fukuda; Yoshiko Atsuta; Masamitsu Yanada

doi:10.1002/jha2.877

Allogeneic hematopoietic cell transplantation for acute myeloid leukemia with BCR::ABL1 fusion

EJHaem. 2024 Mar 30;5(2):369-378. doi: 10.1002/jha2.877. eCollection 2024 Apr.

Authors

Shohei Mizuno¹, Akiyoshi Takami¹, Koji Kawamura², Kaito Harada³, Masuko Masayoshi⁴, Shingo Yano⁵, Ayumu Ito⁶, Yukiyasu Ozawa⁷, Fumihiko Ouchi⁸, Takashi Ashida⁹, Yuichiro Nawa¹⁰, Tatsuo Ichinohe¹¹, Takahiro Fukuda⁶, Yoshiko Atsuta^{12

13}, Masamitsu Yanada¹⁴

Affiliations

¹ Department of Internal Medicine Division of Hematology Aichi Medical University of School of Medicine Nagakute Japan.
² Department of Hematology Tottori University Hospital Yonago Japan.
³ Department of Hematology and Oncology Tokai University School of Medicine Isehara Japan.
⁴ Department of Hematopoietic Cell Therapy Niigata University Medical and Dental Hospital Niigata Japan.
⁵ Division of Clinical Oncology and Hematology The Jikei University School of Medicine Tokyo Japan.
⁶ Department of Hematopoietic Stem Cell Transplantation National Cancer Center Hospital Tokyo Japan.
⁷ Department of Hematology Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Nagoya Japan.
⁸ Hematology Division Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan.
⁹ Division of Hematology and Rheumatology Kindai University Hospital Osakasayama Japan.
¹⁰ Division of Hematology Ehime Prefectural Central Hospital Ehime Japan.
¹¹ Department of Hematology and Oncology Research Institute for Radiation Biology and Medicine Hiroshima University Hiroshima Japan.
¹² Japanese Data Center for Hematopoietic Cell Transplantation Nagakute Japan.
¹³ Department of Registry Science for Transplant and Cellular Therapy Aichi Medical University School of Medicine Nagakute Japan.
¹⁴ Department of Hematology and Oncology Nagoya City University East Medical Center Nagoya Japan.

Abstract

BCR::ABL1 fusion is found in < 1% of de novo acute myeloid leukemia (AML) cases and confers a poor prognosis. This Japanese nationwide survey analyzed patients with AML (n = 22) and mixed phenotype acute leukemia (MPAL) (n = 10) with t(9;22) or BCR::ABL1 who underwent allogeneic hematopoietic cell transplantation (allo-HCT) between 2002 and 2018. The 3-year overall survival (OS) rates were 81.3% and 56.0%, respectively (p = 0.15), and leukemia-free survival (LFS) rates were 76.2% and 42.0%, respectively (p = 0.10) in patients with AML and MPAL. The relapse rates were 9.5% and 14.0% (p = 0.93), and the non-relapse mortality (NRM) rates were 14.3% and 44.0%, respectively (p = 0.10) in patients with AML and MPAL. One in 17 patients with AML, with pre-transplant tyrosine kinase inhibitors (TKI), and three in five patients with AML, without pre-transplant TKI, did not achieve complete remission (CR) before allo-HCT (p = 0.024). Among the 20 patients with known disease status after allo-HCT, 95.0% were in hematological or molecular CR. None of the four patients who received post-transplant TKI for prophylaxis or measurable residual disease relapse experienced hematological relapse. In conclusion, our results suggest that pre-transplant TKI could improve disease status before allo-HCT. Moreover, allo-HCT resulted in high OS, high LFS, low relapse, and low NRM rates in patients with AML with BCR::ABL1.

Keywords: BCR::ABL1; acute myeloid leukemia; allogeneic hematopoietic cell transplantation.