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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.

Author information

1
Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden. anna.lubking@gmail.com.
2
Department of Hematology, Linköping University Hospital, Linköping, Sweden.
3
Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
4
Department of Hematology, Umeå University Hospital, Umeå, Sweden.
5
Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden.
6
Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Section of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
7
Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
8
Department of Medicine, Division of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden.
9
Department of Medical Sciences, Division of Hematology, Uppsala University Hospital, Uppsala, Sweden.

Abstract

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.

PMID:
30962502
DOI:
10.1038/s41409-019-0513-5

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