Allogeneic stem cell transplantation for patients with chronic myeloid leukemia: Risk stratified approach with a long‐term follow‐up

Abstract

The use of allogeneic stem cell transplantation (SCT) for chronic myeloid leukemia (CML) was almost abandoned in recent years for very effective targeted therapy with tyrosine kinase inhibitors (TKIs). However, approximately one third of patients still need another treatment including SCT. 38 consecutive CML patients were treated (most in preimatinib era) with allogeneic SCT, using partial T cell depletion (TCD) and preemptive donor lymphocyte infusion (DLI), without post-transplant graft-versus-host disease (GvHD) prophylaxis. Conditioning included busulfan, cyclophosphamide, antithymocytic globulin, and fludarabine followed by donor stem cell transfusion. With a median follow up of 90.5 months (1-134), 32 patients are alive. 97% engrafted. 5-year leukemia free survival (LFS) and overall survival (OS) were 78.95% and 84.2%, respectively. All patients are in major molecular remission and 78% in complete molecular remission. Transplantrelated mortality (TRM) was 13%. Twenty-four patients received DLI for residual disease. Acute GvHD, mostly Grades I-II, occurred in 18% of patients post-transplant and in 24% of patients receiving DLI. In conclusion, the risk-adapted approach using only partial TCD and preemptive escalated dose of DLI precluded the need for immunosuppressive medications and reduced the risk of significant GvHD without compromising engraftment and long-term disease control. Am. J. Hematol. 87:875-879, 2012. V

The Impact of Pretransplant Use of Tyrosine Kinase Inhibitors on Allogeneic Stem Cell Transplantation in Patients with Chronic Myeloid Leukemia - A Single-institution Retrospective Study -

“…Pretransplant TKI treatment was continued until the day before the start of the conditioning regimen. Relapse included molecular relapse, as previously reported ( 23 - 25 ), and was defined as follows: progression to AP/BP, hematologic relapse, cytogenetic relapse, or molecular relapse. Molecular relapse was defined as positivity for BCR::ABL transcripts in quantitative reverse transcription polymerase chain reaction (RT-PCR) with a BCR::ABL to ABL of ≥10 -5 in at least 2 measurements.…”

Chronic Myeloid Leukemia–Transplantation in the Tyrosine Kinase Era

“…Some of the questions are addressed by the recent literature on transplant outcome in CML, which is summarized in Table 3. [41][42][43][44][45][46][47][48][49][50][51][52] Do Transplant Outcome Data from the Pre-Imatinib Era Translate to Patients Who Have Tried and Failed Tyrosine Kinase Inhibitor Therapy?…”