Survival disparities in Philadelphia chromosome-positive vs. Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia in the era of modern therapeutic approaches: a decade-long surveillance, epidemiology, and end results (SEER) data based investigation (2010-2021).
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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. A retrospective cohort study involving 14,175 patients diagnosed with B-ALL from 2010 to 2021 was 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. The cohort's mean age was 29.6 years (SD = 26.1), with 54.7% male and 43.6% Caucasian. Ph + patients comprised 7.3% of the cohort. Treatments included chemotherapy (90.9%) and radiation therapy (9.3%). The mean OS for Ph + patients was 49.75 months (95% CI: 47.098-52.402), whereas Ph- patients had a significantly longer OS of 66.541 months (95% CI: 65.715-67.366) (p < .001). Similarly, the mean CSS was 88.2 months (95% CI: 83.3-93) for Ph + patients and 103.2 months (95% CI: 102.1-104.3) for Ph- patients (p < .001). Temporal analysis of the last three years revealed no significant differences in OS (Ph+: 27.7 months vs. Ph-: 26.6 months, p = .145) or CSS (Ph+: 28.1 months vs. Ph-: 29 months, p = .183). Significant predictors of reduced OS and CSS included male sex (OS HR: 1.073, p = .019; CSS HR: 1.070, p = .041), older age (OS HR: 1.039, p < .001; CSS HR: 1.038, p < .001), and lack of chemotherapy (OS HR: 0.617, p < .001; CSS HR: 0.625, p < .001). Race was not a significant predictor of survival outcomes. This study highlights the comparable survival rates in Ph + and Ph- ALL patients in recent years. Demographic factors and treatment modalities, particularly chemotherapy, 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.