Dissecting survival disparities in Philadelphia chromosome–positive vs. negative B-cell acute lymphoblastic leukemia: A decade-long Surveillance, Epidemiology, and End Results (SEER) data-based investigation (2010–2021).

Abstract

e18521 Background: Philadelphia chromosome (Ph) status is a critical prognostic marker in B-cell acute lymphoblastic leukemia (B-ALL). This study evaluates the impact of Ph-positive (Ph+) and Ph-negative (Ph−) status on overall survival (OS) and cancer-specific survival (CSS) while analyzing the role of demographic and treatment variables. Methods: A retrospective cohort study involving 14,175 patients diagnosed with B-ALL from 2010-2021 were analyzed in this investigation. Primary outcomes were OS and CSS, analyzed using hazard ratios (HRs) with 95% confidence intervals (CIs) and associated p-values. Subgroup analysis by year assessed temporal trends in survival outcomes. Statistical analysis and survival rate (OS and CSS) estimations were performed using SEER*Stat software. Results: The cohort's mean age was 29.6 years (SD = 26.1), with 54.7% male and 43.6% White. Ph+ patients comprised 7.3% of the cohort. Chemotherapy was administered to 90.9% of patients. Ph− patients had significantly better OS (96.8 months, 95% CI: 95.6–97.9) compared to Ph+ patients (75.8 months, 95% CI: 71.1–80.6, p < 0.001). Similarly, CSS was higher in Ph− patients (103.2 months, 95% CI: 102.1–104.3) versus Ph+ patients (88.2 months, 95% CI: 83.3–93.0, p < 0.001). Temporal analysis of the last three years revealed no significant differences in OS (Ph+: 27.7 months vs. Ph−: 26.6 months, p = 0.145) or CSS (Ph+: 28.1 months vs. Ph−: 29 months, p = 0.183). Significant predictors of reduced OS and CSS included male sex (OS HR: 1.073, p = 0.019; CSS HR: 1.070, p = 0.041), older age (OS HR: 1.039, p < 0.001; CSS HR: 1.038, p < 0.001), and chemotherapy (OS HR: 0.617, p < 0.001; CSS HR: 0.625, p < 0.001). Race was not a significant predictor of survival outcomes. Conclusions: This study highlights the prognostic difference in Ph+ and Ph- ALL has been reduced drastically, likely due to recent advances in Ph+ therapy. Demographic factors and treatment modalities, particularly chemotherapy and radiation, play significant roles in modulating survival outcomes. These findings underscore the importance of individualized treatment strategies based on Ph status and other prognostic indicators in B-ALL management. Multivariate Cox regression model for OS and CSS. Variable OS HR OS Lower CI OS Higher CI OS p-value CSS HR CSS Lower CI CSS p-value Male sex 1.073 1.011 1.139 0.019 1.070 1.003 0.041 Philadelphia Status 0.865 0.780 0.960 0.006 0.800 0.712 <0.001 Chemotherapy 0.617 0.567 0.672 <0.001 0.625 0.568 <0.001 Age 1.039 1.038 1.041 <0.001 1.038 1.037 <0.001 Black* 0.962 0.848 1.090 0.541 0.944 0.821 0.418 Hispanic* 1.013 0.950 1.080 0.693 1.037 0.967 0.311 American Indian / Alaska Native* 1.075 0.800 1.445 0.632 1.100 0.797 0.563 Asian or Pacific Islander* 0.938 0.840 1.048 0.259 0.949 0.840 0.394 *Reference: White.