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; nilotinib 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<0.001) and EFS (47.1 vs 6.7%, P<0.001) compared to TKI treatment alone. Hemoglobin <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.

• Authors: H Jiang, L-P Xu, D-H Liu, K-Y Liu, S-S Chen, B Jiang, Q Jiang, H Chen, Y-H Chen, W Han, X-H Zhang, Y Wang, J-Z Wang, F-R Wang, Y-Z Qin, Y-Y Lai, X-J Huang
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 49 Issue 9 Pg. 1146-54 (Sep 2014) ISSN: 1476-5365 [Electronic] England
• PMID: 25046218 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Protein Kinase Inhibitors

Topics

• Adolescent
• Adult
• Combined Modality Therapy
• Female
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (drug therapy, therapy)
• Male
• Middle Aged
• Protein Kinase Inhibitors (therapeutic use)
• Retrospective Studies
• Transplantation Conditioning (methods)
• Treatment Outcome
• Young Adult