Management of Philadelphia chromosome-positive B-acute lymphoblastic leukemia in Tunisia

The management of Philadelphia-chromosome positive B-cell acute lymphoblastic leukemia (Ph+ B- ALL) is continuously progressing. However, Tunisian data are limited.

The objective was to describe the clinical and prognostic profile as well as the therapeutic outocomes of Ph+ B- ALL.

This was a retrospective and descriptive study conducted in the adult clinical hematology department of Aziza Othmana hospital over a period of 12 years. We included patients aged between 18 and 60 years, diagnosed with de novo or secondary Ph+ B- ALL and treated with a combination of chemotherapy and a tyrosine kinase inhibitor (TKI).

We collected data on 36 patients with initial central nervous system involvement in only one case. The GRAAPH-2005 protocol was the most used regimen (n=29). Thirty-four patients received TKI: imatinib (n=28) and dasatinib (n=6). After induction, all patients achieved cytological remission. Molecular response was assessed in 21 of whom 52% achieved a molecular response. After consolidation, 17 had molecular response evaluation, with 13 achieving a molecular response. Seven patients underwent allogenic hematopoietic stem cell transplantation, and two underwent autologous stem cell transplantation. In terms of disease progression ,14 patients relapsed with a median time to relapse of 18 months [4-42] after TKI initiation. The 5- year overall survival in our series was 25%. The 5-year relapse free survival and event-free survival were 22% respectively.

Our study highlighted the various obstacles encountered in the management of Ph+ B-ALL in Tunisia. Addressing these obstacles could improve therapeutic outcomes.