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Bone Marrow Transplant. 2019 Nov;54(11):1764-1774. doi: 10.1038/s41409-019-0513-5. Epub 2019 Apr 8.

Allogeneic stem cell transplantation for chronic myeloid leukemia in the TKI era: population-based data from the Swedish CML registry.

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Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
Department of Hematology, Linköping University Hospital, Linköping, Sweden.
Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
Department of Hematology, Umeå University Hospital, Umeå, Sweden.
Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Section of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
Department of Medicine, Division of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden.
Department of Medical Sciences, Division of Hematology, Uppsala University Hospital, Uppsala, Sweden.


Two decades after the introduction of tyrosine kinase inhibitors (TKI), a sizeable portion of patients with chronic myeloid leukemia (CML) in chronic phase (CP) still undergo allogeneic stem cell transplantation (allo-HSCT). We investigated the indications for allo-HSCT, clinical outcome, management of relapse, and post-transplant TKI treatment in a population-based setting using the Swedish CML registry. Of 118 CML patients transplanted between 2002 and 2017, 56 (47.4%) received allo-HSCT in first CP, among whom TKI resistance was the most common transplant indication (62.5%). For patients diagnosed with CML in CP at <65 years of age, the cumulative probability of undergoing allo-HSCT within 5 years was 9.7%. Overall 5-year survival was 96.2%, 70.1% and 36.9% when transplanted in first CP, second or later CP, and in accelerated phase or blast crisis, respectively. Risk factors for relapse were EBMT score >2 and reduced intensity conditioning, and for death, CP > 2 at time point of allo-HSCT only. Non-relapse mortality for patients transplanted in CP was 11.6%. Our data indicate that allo-HSCT still constitutes a reasonable therapeutic option for patients with CML in first CP, especially those resistant to TKI treatment, providing high long-term survival and low non-relapse mortality.


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