Prognostic factors for outcomes in allogeneic transplantation for CML in the imatinib era: A CIBMTR analysis

Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA.
Bone marrow transplantation (Impact Factor: 3.57). 10/2011; 47(6):810-6. DOI: 10.1038/bmt.2011.194
Source: PubMed


Allogeneic hematopoietic SCT is an effective treatment in accelerated (AP) or blast phase (BP) CML. Imatinib (IM) has transient but significant activity in advanced phases of CML, which may permit early allografting for responding patients. To identify prognostic factors in allograft recipients previously treated with IM, we analyzed 449 allogeneic hematopoietic SCTs performed from 1999 to 2004 in advanced-phase CML, using the data reported to the Center for International Blood and Marrow Transplant Research. CML patients in second chronic phase (CP2, n=184), AP (n=185) and BP (n=80) received HLA-identical sibling (27%), related (3%), or matched or mismatched unrelated donor (70%), peripheral blood (47%) or BM (53%) hematopoietic SCT after myeloablative (78%) or non-myeloablative (22%) conditioning. In all, 52% in CP2, 49% in AP and 46% in BP received IM before hematopoietic SCT. Disease-free survival was 35-40% for CP2, 26-27% for AP and 8-11% for BP. Cumulative incidence of acute and chronic GVHD and TRM were not affected by the stages of CML or pre-hematopoietic SCT IM exposure. Multivariate analyses showed that conventional prognostic indicators remain the strongest determinants of transplant outcomes. In conclusion, there are no new prognostic indicators of the outcomes of allogeneic hematopoietic SCT for advanced-phase CML in the IM era.

Download full-text


Available from: Philip L Mccarthy, Mar 15, 2014
30 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Allogeneic stem cell transplantation (SCT) had traditionally been the first-line therapy of chronic myeloid leukaemia (CML), but the introduction of tyrosine kinase inhibitors (TKI) has caused a major change to the treatment algorithm. The majority of patients in chronic phase obtain an excellent response to these oral agents with minimal toxicity. SCT is therefore used only in a minority of patients who do not achieve adequate response to first-, second- or even third-generation agents. Patients in accelerated phase are less likely to achieve an optimal response and for patients in blast phase, SCT continues to be the only therapy with curative potential although it is now increasingly used in combination with TKI. This review discusses the place of SCT in the current therapy of CML.
    memo - Magazine of European Medical Oncology 12/2012; 5(4). DOI:10.1007/s12254-012-0042-z
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade, numerous advances have been made in elucidating the biology of and improving treatment for chronic lymphocytic leukemia (CLL). These studies have led to identification of select CLL patient groups that generally have short survival dating from time of treatment or initial disease relapse who benefit from more aggressive therapeutic interventions. Allogeneic transplantation represents the only potentially curative option for CLL, but fully ablative regimens applied in the past have been associated with significant morbidity and mortality. Reduced-intensity preparative regimens has made application of allogeneic transplant to CLL patients much more feasible and increased the number of patients proceeding to this modality. Arising from this has been establishment of guidelines where allogeneic stem cell transplantation should be considered in CLL. Introduction of new targeted therapies with less morbidity, which can produce durable remissions has the potential to redefine where transplantation is initiated in CLL. This review briefly summarizes the field of allogeneic stem cell transplant in CLL and the interface of new therapeutics with this modality.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 01/2012; 18(1 Suppl):S132-8. DOI:10.1016/j.bbmt.2011.11.018 · 3.40 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The introduction of tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) led to a dramatic change in the role of allogeneic stem cell transplantation (SCT) with a rapid decline in the number of patients receiving SCT in first chronic phase (CP1). We evaluated 68 consecutive patients in all phases of CML (male/female = 39:29, 27 in CP1), who received SCT from related/unrelated donors (related/unrelated = 23:45) under myeloablative or reduced intensity conditioning (MAC/RIC = 45:23). Forty-eight patients (71 %) received TKIs pre-SCT, 20 patients post-SCT (29 %). Overall survival (OS) of CP1 patients achieved a plateau of 85 % at 10 months. Relapse-free survival (RFS) of CP1 patients was 85 % at 1 and 2 years, and 81 % at 5 years. Multivariate analysis showed adverse OS and RFS for patients transplanted >CP1 (hazard ratio (HR) = 6.61 and 4.62) and those who had grade III-IV aGvHD (HR = 2.45 and 1.82). Patients with advanced CML had estimated OS of 65 and 47 %; and RFS of 41 and 32 % at 1 and 2 years respectively. Therefore, for patients with advanced CML phases, allogeneic SCT provides an acceptable chance of cure. Transplant research should focus on improving conditioning regimens and post-SCT management for this subgroup of CML patients.
    Annals of Hematology 12/2012; 92(4). DOI:10.1007/s00277-012-1650-8 · 2.63 Impact Factor
Show more