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<p>This study compared dasatinib and imatinib in adult Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). Using pooled data from three JALSG prospective trials (Ph + ALL202, Ph + ALL208, Ph + ALL213), we analyzed outcomes for 206 patients aged 15–64&#xa0;years treated with dasatinib (<i>n</i> = 74) or imatinib (<i>n</i> = 132) in combination with chemotherapy. We applied propensity score matching (1:1) and inverse probability of treatment weighting to minimize selection bias and balance baseline characteristics. Dasatinib plus chemotherapy was associated with significantly higher complete molecular response rates after induction therapy compared with imatinib. In the propensity score-matched cohort (<i>n</i> = 68 patients per group), 3-year event-free survival (EFS) was significantly higher with dasatinib (73 vs. 49%, <i>P</i> = 0.01), as was 3-year overall survival (OS) (85 vs. 60%, <i>P</i> = 0.004). Multivariate analysis, incorporating allogeneic stem cell transplantation in first complete remission as a covariate, confirmed that dasatinib had an independent favorable prognostic impact on EFS (hazard ratio [HR], 0.54; <i>P</i> = 0.02) and OS (HR, 0.39; <i>P</i> = 0.003). Although the 3-year cumulative incidence of relapse tended to be lower with dasatinib (18 vs. 40%, <i>P</i> = 0.07), non-relapse mortality was comparable between groups (8.8 vs. 12%, <i>P</i> = 0.33). This analysis demonstrates improved survival with dasatinib-based therapy in adult Ph + ALL, informing tyrosine kinase inhibitor selection in treatment planning.</p>

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Dasatinib is superior to imatinib in adult Ph + ALL: a propensity score-matched analysis of pooled JALSG trial data

  • 期刊论文

  • 发表日期：

    2025年8月27日

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  • Satoshi Nishiwaki,
  • Isamu Sugiura,
  • Shin Fujisawa,
  • Yoshihiro Hatta,
  • Yoshiko Atsuta,
  • Noriko Doki,
  • Shingo Kurahashi,
  • Yasunori Ueda,
  • Nobuaki Dobashi,
  • Tomoya Maeda,
  • Itaru Matsumura,
  • Masatsugu Tanaka,
  • Shinichi Kako,
  • Tatsuo Ichinohe,
  • Takahiro Fukuda,
  • Shigeki Ohtake,
  • Yuichi Ishikawa,
  • Yasushi Miyazaki,
  • Emiko Sakaida,
  • Yoshinobu Maeda,
  • Takahiro Yamauchi,
  • Hitoshi Kiyoi

摘要

This study compared dasatinib and imatinib in adult Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). Using pooled data from three JALSG prospective trials (Ph + ALL202, Ph + ALL208, Ph + ALL213), we analyzed outcomes for 206 patients aged 15–64 years treated with dasatinib (n = 74) or imatinib (n = 132) in combination with chemotherapy. We applied propensity score matching (1:1) and inverse probability of treatment weighting to minimize selection bias and balance baseline characteristics. Dasatinib plus chemotherapy was associated with significantly higher complete molecular response rates after induction therapy compared with imatinib. In the propensity score-matched cohort (n = 68 patients per group), 3-year event-free survival (EFS) was significantly higher with dasatinib (73 vs. 49%, P = 0.01), as was 3-year overall survival (OS) (85 vs. 60%, P = 0.004). Multivariate analysis, incorporating allogeneic stem cell transplantation in first complete remission as a covariate, confirmed that dasatinib had an independent favorable prognostic impact on EFS (hazard ratio [HR], 0.54; P = 0.02) and OS (HR, 0.39; P = 0.003). Although the 3-year cumulative incidence of relapse tended to be lower with dasatinib (18 vs. 40%, P = 0.07), non-relapse mortality was comparable between groups (8.8 vs. 12%, P = 0.33). This analysis demonstrates improved survival with dasatinib-based therapy in adult Ph + ALL, informing tyrosine kinase inhibitor selection in treatment planning.