Outcomes and toxicity of allogeneic hematopoietic cell transplantation in chronic myeloid leukemia patients previously treated with second-generation tyrosine kinase inhibitors: a prospective non-interventional study from the Chronic Malignancy Working Party of the EBMT.

Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) remains a treatment option for patients with chronic myeloid leukemia (CML) who fail to respond to tyrosine kinase inhibitors (TKIs). While imatinib seems to have no adverse impact on outcomes after transplant, little is known on the effects of prior use of second-generation TKI (2GTKI). We present the results of a prospective non-interventional study performed by the EBMT on 383 consecutive CML patients previously treated with dasatinib or nilotinib undergoing allo-HCT from 2009 to 2013. The median age was 45 years (18-68). Disease status at transplant was CP1 in 139 patients (38%), AP or >CP1 in 163 (45%), and BC in 59 (16%). The choice of 2GTKI was: 40% dasatinib, 17% nilotinib, and 43% a sequential treatment of dasatinib and nilotinib with or without bosutinib/ponatinib. With a median follow-up of 37 months (1-77), 8% of patients developed either primary or secondary graft failure, 34% acute and 60% chronic GvHD. There were no differences in post-transplant complications between the three different 2GTKI subgroups. Non-relapse mortality was 18% and 24% at 12 months and at 5 years, respectively. Relapse incidence was 36%, overall survival 56% and relapse-free survival 40% at 5 years. No differences in post-transplant outcomes were found between the three different 2GTKI subgroups. This prospective study demonstrates the feasibility of allo-HCT in patients previously treated with 2GTKI with a post-transplant complications rate comparable to that of TKI-naive or imatinib-treated patients.

• Authors: Stavroula Masouridi-Levrat, Eduardo Olavarria, Simona Iacobelli, Mahmoud Aljurf, Elena Morozova, Riitta Niittyvuopio, Henrik Sengeloev, Peter Reményi, Grzegorz Helbig, Paul Browne, Arnold Ganser, Arnon Nagler, John A Snowden, Marie Robin, Jakob Passweg, Gwendolyn Van Gorkom, Hélène Labussière Wallet, Jennifer Hoek, Henric-Jan Blok, Theo De Witte, Nicolaus Kroeger, Patrick Hayden, Yves Chalandon, Ibrahim Yakoub Agha
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 57 Issue 1 Pg. 23-30 (01 2022) ISSN: 1476-5365 [Electronic] England
• PMID: 34599284 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. The Author(s).

Chemical References

• Protein Kinase Inhibitors
• Imatinib Mesylate
• Dasatinib

Topics

• Dasatinib (adverse effects)
• Graft vs Host Disease (etiology)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Imatinib Mesylate (adverse effects)
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (drug therapy)
• Middle Aged
• Prospective Studies
• Protein Kinase Inhibitors (adverse effects)