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

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Published Apr 1, 2026
https://doi.org/10.62438/tunismed.v104i02.6158
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Vol. 104 No. 02 (2026): Tunis Med Fev 2026

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Wiem Chaaouri
Department of clinical hematology,  Aziza Othmana Hospital,  Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Hela Sahbani
Departement of clinical hematology,  Aziza Othmana Hospital,  Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Salma Kefi
Departement of clinical hematology,  Aziza Othmana Hospital,  Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Meriem Achour
Departement of clinical hematology,  Aziza Othmana Hospital,  Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Wiem Ayed
Cytogenetics department, Pasteur institute of Tunis, Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Ahlem Laamouri
Cytogenetics department, Pasteur institute of Tunis, Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Hend Chaker
Cytogenetics department, Pasteur institute of Tunis, Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Sarra Fekih
Department of biological hematology,   Aziza Othmana Hospital , Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Fatma Ben Lakhal
Department of biological hematology,   Aziza Othmana Hospital , Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Wijden Borgi
Department of biological hematology,   Aziza Othmana Hospital , Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Emna Gouider
Department of biological hematology,   Aziza Othmana Hospital , Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Samia Menif
Department of biological hematology,   Aziza Othmana Hospital , Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Hend Ben Neji
Departement of clinical hematology,  Aziza Othmana Hospital,  Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia
Raihane BenLakhal
Departement of clinical hematology,  Aziza Othmana Hospital,  Faculty of Medicine of Tunis,University of Tunis El Manar,1007, Tunis, Tunisia

Abstract

Introduction: The management of Philadelphia-chromosome positive B-cell acute lymphoblastic leukemia (Ph+ B- ALL) is continuously progressing.
However, Tunisian data are limited.
Aim: The objective was to describe the clinical and prognostic profile as well as the therapeutic outocomes of Ph+ B- ALL.
Methods: 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).
Results: 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.
Conclusion: Our study highlighted the various obstacles encountered in the management of Ph+ B-ALL in Tunisia. Addressing these obstacles could
improve therapeutic outcomes.

Keywords:

Acute lymphoblastic leukemia, Philadelphia chromosome, Tyrosine kinase inhibitor, Prognostic, Clinical profile, Chemotherapy

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