Allogeneic hematopoietic SCT in combination with tyrosine kinase inhibitor treatment compared with TKI treatment alone in CML blast crisis

Abstract

CML treatment with tyrosine kinase inhibitors (TKIs) has improved many patients' prognosis, but during the disease's terminal phase, the blast crisis (CML-BC), has been disappointing. Allo-HSCT is another treatment, but survival rates are still disappointing. Currently, a combination of these two is suggested but with little evidence. This retrospective comparison reports on this combination and TKI alone for treatment of CML-BC. Of the 83 CML-BC patients, 45 received TKIs (imatinib; nilotinb or dasatinib after imatinib resistance; TKIs group) and 38 were treated with allo-HSCT after TKI (TKIs+allo-HSCT group). Treatment success was measured in terms of the hematologic, cytogenic and molecular responses, and subject outcome. Follow-up was 30-126 months or until death. Univariate and multivariate analyses determined EFS and OS predictors. Allo-HSCT significantly improved the 4-year OS (46.7 vs 9.7%, P o 0.001) and EFS (47.1 vs 6.7%, P o 0.001) compared to TKI treatment alone. Hemoglobin o 100 g/L, non-return to chronic phase after TKI therapy and TKI treatment alone are independent adverse predictors of OS and EFS. Allo-HSCT with individualized intervention after TKI therapy is superior to TKI alone for CML-BC.

Management of chronic myeloid leukemia in blast crisis

“…However, in general, if BC evolves under TKI treatment, transplantation is recommended whenever possible [61] after attempting to achieve at least a second hematologic remission before transplantation.…”

One-step formation of lipid-polyacrylic acid-calcium carbonate nanoparticles for co-delivery of doxorubicin and curcumin

“…As a superior strategy to circumvent multi-drug resistant (MDR) effects, combination therapy is generally applied for advanced tumours (Misra andSahoo, 2011, Huang et al, 2015) and in terminal cancer patients (Jiang et al, 2014). A large number of drug delivery systems (DDSs) have been developed, with the aim of achieving targeted drug delivery to tumour tissues and cells.…”

Allogeneic transplantation of hematopoietic stem cells: Perspectives and alternatives, own experience

“…РИК с деци-табином, флударабином и ТОТ (2 Гр) перед алло-ТГСК при МДС, ХМЛ и ОМЛ индуцирует опухолеассоции-рованный антиген-специфический Т-клеточный ответ (M. Cruijsen et al, 2016) [38]. Терапия ингибиторами ти-розинкиназ до и после трансплантации при Ph(+)-лей-козах, особенно с достижением МРБ-негативности значительно улучшает результаты алло-ТГСК не только с ОЛЛ, но и в бластном кризе ХМЛ (H. Jiang et al, 2014) [39]. Назначение ибрутиниба после алло-ТГСК, вы-полненной больнымс рецидивом ХЛЛ (n = 27), способ-ствовало усилению эффекта ТПЛ (переход смешанного химеризма в полный, достижение МРБ-негативности даже после прекращения приема ибрутиниба), а также отсутствию РТПХ (C. Ryan et al, 2016) [40].…”