The early referral for reduced-intensity stem cell transplantation in patients with Ph1 (+) chronic myelogenous leukemia in chronic phase in the imatinib era: results of the Latin American Cooperative Oncohematology Group (LACOHG) prospective, multicenter study

Abstract

Summary:Using a reduced-intensity stem cell transplantation (RIST) schedule, 24 patients with Philadelphia (Ph1) ( þ ) chronic myelogenous leukemia (CML) in first chronic phase (CP) were prospectively allografted in four Latin American countries: Me´xico, Brazil, Colombia and Venezuela, using HLA-identical siblings as donors. The median age of the patients was 41 years (range 10-71 years); there were eight females. Patients received a median of 4.4 Â 10 6 /kg CD34 cells. The median time to achieve above 0.5 Â 10 9 /l granulocytes was 12 days, range 0-41 days, and the median time to achieve above 20 Â 10 9 /l platelets was also 12 days, range 0-45 days. In all, 22 patients are alive 81-830 (median 497) days after RIST. The 830-day probability of survival is 92%, and the median survival has not been reached, being beyond 830 days. A total of 11 patients (46%) developed acute graftversus-host disease (GVHD), and seven of 23 (30%) developed chronic GVHD. Two patients died 43 and 210 days after RIST, one as a result of sepsis and the other of chronic GVHD. The 100-day mortality was 4.4%, and transplant-related mortality was 8%. RIST for patients with CML in CP appears to be an adequate therapeutic option.

Stem Cell Applications for Treatment of Cancer and Autoimmune Diseases: Its Promises, Obstacles, and Future Perspectives

“…Allogeneic RIST has been introduced as an important procedure to achieve complete remission in patients with leukemia, especially if a human leukocyte antigen-compatible donor is used. [58][59][60][61][62][63] However, one of the main obstacles to successful transplantation is GVHD. Nonetheless, the frequency of GVHD is perceptibly reduced compared to that of the first treatment, 64 with a significantly reduced mortality rate.…”

Chronic Myelogenous Leukemia: Role of Stem Cell Transplant in the Imatinib Era

“…Ruiz-Argüelles et al reported data on 24 patients transplanted in CP1 using matched sibling donor and RIC in four Latin American countries. 47 They mentioned the cost of allo-SCT in Mexico would be equal to approximately 200 days of imatinib 400mg daily, thus making the case for allo-SCT. 47 Similar observations were made by Gratwohl and colleagues when they analyzed the EBMT survey data.…”

“…47 They mentioned the cost of allo-SCT in Mexico would be equal to approximately 200 days of imatinib 400mg daily, thus making the case for allo-SCT. 47 Similar observations were made by Gratwohl and colleagues when they analyzed the EBMT survey data. 48 They noticed that the rates of allo-SCT fell after the introduction of imatinib in high-income countries in Europe but they remained relatively stable for the lower income countries, indicating persistent reliance on the ‘one-time’ cost of allo-SCT as compared to expensive potentially ‘life-long’ TKI therapy.…”

“…For patients with high-risk CML by Sokal / Hasford criteria, 120,121 a case for early transplantation in CP1 could be made, especially if they have low EBMT score or HCT-CI. However, in practical terms, this is a small population of individuals and given the effectiveness of TKIs, unless there are other mitigating factors (such as economic considerations), 47,48 almost all newly diagnosed CML patients are offered TKIs upfront.…”