Relapse of chronic myeloid leukemia after allogeneic stem cell transplantation: outcome and prognostic factors. The Chronic Myeloid Leukemia Subcommittee of the GETH (Grupo Español de Trasplante Hemopoyético)

Martı́nez, Carmen; Gomez, Virginia Escamilla; Tomás, J F; Parody, Ricardo; Sureda, A; Sanz, Guillermo; Cañizo, C; Díez, José Luis; Boqué, Concha

doi:10.1038/sj.bmt.1705063

Cited by 10 publications

(6 citation statements)

References 23 publications

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“…The effectiveness of TKIs and donor lymphocyte infusions in extending survival following relapse in CML 27 , and the limited (5 years) follow up of the present study probably account for similar OS despite the differences in relapse and LFS. Nevertheless, cure is the ultimate goal of HCT in CML.…”

Section: Discussionmentioning

confidence: 64%

Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation

Copelan

Avalos

Ahn

et al. 2015

Biology of Blood and Marrow Transplantation

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Cyclophosphamide in combination with busulfan (Bu) or total body irradiation (TBI) are the most commonly used myeloablative conditioning regimens in patients with Chronic Myeloid Leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase following myeloablative conditioning with cyclophosphamide (Cy) in combination with TBI, oral Bu or intravenous (IV) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving IV Bu compared to TBI (RR=0.36; P=0.022) or oral Bu (RR=0.39; P=0.028), but non-relapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving IV (RR=0.53; P=0.025) or oral Bu (RR=0.64; P=0.017) compared to TBI. In CML in first chronic phase, Cy in combination with IV Bu was associated with less relapse than TBI or oral Bu. LFS was better following IV or oral Bu compared to TBI.

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Section: Discussionmentioning

confidence: 64%

Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation

Copelan

Avalos

Ahn

et al. 2015

Biology of Blood and Marrow Transplantation

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“…Children and young adults are known to better tolerate HCT, in general, and they typically enjoy superior outcomes compared to older adults. 12,24,25,26,27 Additionally, advances in supportive care, have led to significant reduction in the incidence and impact of HCT-related complications. 25,26,27 …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Allogeneic Hematopoietic Cell Transplantation in Children and Young Adults with Chronic Myeloid Leukemia: A CIBMTR Cohort Analysis

Chaudhury

Sparapani

et al. 2016

Biology of Blood and Marrow Transplantation

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Chronic myeloid leukemia (CML) in children and young adults is uncommon. Young patients have long life expectancies and low morbidity with hematopoietic cell transplantation (HCT). Prolonged tyrosine kinase inhibitor (TKI) use may cause significant morbidity. In addition indication for HCT in patients in first chronic phase is not established. We hence retrospectively evaluated outcomes in 449 CML patients with early disease receiving myeloablative HCT reported to the CIBMTR. We analyzed various factors affecting outcome specifically the effect of age and pre-HCT TKI in pediatric patients (<18 yrs, n= 177) and young adults (18–29 years, n=272) with the goal of identifying prognostic factors. Post-HCT probability of 5 y overall survival (OS) and leukemia free survival (LFS) were 75% and 59% respectively. OS and LFS were 76%, 57% in <18 yr and 74%, 60% in 18–29 yr group respectively by univariate analysis (p= 0.1 and 0.6). Five-year OS for human leukocyte antigen (HLA) matched sibling donor (MSD) and bone marrow (BM) stem cell source were 83% and 80% respectively. In multivariate analysis, there was no effect of age (<18 vs 18–29) or pre-HCT TKI therapy on OS, LFS, transplant related mortality (TRM) or relapse. Favorable factors for OS were MSD (p<0.001) and recent HCT (2003–2010) (p=0.04). LFS was superior with MSD (P<0.001), BM as graft source (P=0.001) and performance score >90 (P=0.03) compared to unrelated or mismatched, peripheral blood stem cells donors and recipients with lower performance scores. Older age was associated with increased incidence of chronic graft vs. host disease (cGVHD) (p=0.0002). In the current era, HCT outcomes are similar in young patients and children with early CML, and best outcomes are achieved with BM grafts and MSD.

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“…Relapse is one of the major causes of treatment failures of allogeneic hematopoietic cell transplantation (HCT) for chronic myeloid leukemia (CML). [1][2][3] The incidence of relapse is higher in patients who underwent transplantation during advanced phases of disease and in those with T-celledepleted grafts. 4,5 Donor lymphocyte infusion (DLI) and tyrosine kinase inhibitors (TKIs) are the standard treatment modalities in this setting.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Long-Term Outcomes of Donor Lymphocyte Infusions and Tyrosine Kinase Inhibitors in Patients With Relapsed CML After Allogeneic Hematopoietic Cell Transplantation

Shanavas

Messner

Kamel‐Reid

et al. 2014

Clinical Lymphoma Myeloma and Leukemia

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Relapse of chronic myeloid leukemia after allogeneic stem cell transplantation: outcome and prognostic factors. The Chronic Myeloid Leukemia Subcommittee of the GETH (Grupo Español de Trasplante Hemopoyético)

Cited by 10 publications

References 23 publications

Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation

Comparison of Outcomes of Allogeneic Transplantation for Chronic Myeloid Leukemia with Cyclophosphamide in Combination with Intravenous Busulfan, Oral Busulfan, or Total Body Irradiation

Outcomes of Allogeneic Hematopoietic Cell Transplantation in Children and Young Adults with Chronic Myeloid Leukemia: A CIBMTR Cohort Analysis

A Comparison of Long-Term Outcomes of Donor Lymphocyte Infusions and Tyrosine Kinase Inhibitors in Patients With Relapsed CML After Allogeneic Hematopoietic Cell Transplantation

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