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Biol Blood Marrow Transplant. 2019 Oct;25(10):2008-2016. doi: 10.1016/j.bbmt.2019.06.028. Epub 2019 Jul 1.

Allogeneic Stem Cell Transplantation for Blast Crisis Chronic Myeloid Leukemia in the Era of Tyrosine Kinase Inhibitors: A Retrospective Study by the EBMT Chronic Malignancies Working Party.

Author information

1
Department of Internal Medicine V; University of Heidelberg, Heidelberg, Germany. Electronic address: aleksandar.radujkovic@med.uni-heidelberg.de.
2
Department of Internal Medicine V; University of Heidelberg, Heidelberg, Germany.
3
EBMT Data Office Leiden, Leiden, The Netherlands.
4
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
5
University Hospital Eppendorf, Hamburg, Germany.
6
University of Freiburg, Freiburg, Germany.
7
Depariment of Internal Medicine III, University Hospital of Munich-Grosshadern, LMU, Munich, Germany.
8
Masaryk University Hospital Brno, Brno, Czech Republic.
9
Medical Park Hospitals, Antalya, Turkey.
10
Universita Cattolica S. Cuore, Rome, Italy.
11
University Hospital, Basel, Switzerland.
12
Nottingham University Hospital, Nottingham, United Kingdom.
13
Charles University Hospital, Pilsen, Czech Republic.
14
Leiden University Hospital, Leiden, The Netherlands.
15
Hopital St. Louis, Paris, France.
16
University Hospital Gasthuisberg, Leuven, Belgium.
17
Radboud University Medical Centre, Nijmegen, The Netherlands.
18
Hannover Medical School, Hannover, Germany.
19
HUCH Comprehensive Cancer Center, Helsinki, Finland.
20
Manchester Royal Infirmary, Manchester, United Kingdom.
21
Florence Nightingale Sisli Hospital, Istanbul, Turkey.
22
Hospital Sirio-Libanes, Sao Paulo, Brazil.
23
Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
24
CHU de Lille, LIRIC, INSERM U995, Universite de Lille, Lille, France.
25
Division of Hematology, Department of Oncology, University Hospital, Geneva, Switzerland; Faculty of Medicine of Geneva, University of Geneva, Geneva Switzerland.

Abstract

The prognosis of patients with blast crisis (BC) chronic myeloid leukemia (CML) is still dismal. Allogeneic stem cell transplantation represents the only curative treatment option, but data on transplant outcomes are scarce. We therefore conducted a retrospective, registry-based study of adult patients allografted for BC CML, focusing on patients with active disease at transplant and pretransplant prognostic factors. One hundred seventy patients allografted for BC CML after tyrosine kinase inhibitor pretreatment between 2004 and 2016 were analyzed. Before transplant, 95 patients were in remission, whereas 75 patients had active BC. In multivariable analysis of the entire cohort, active BC at transplant was the strongest factor associated with decreased overall survival (hazrd ratio, 1.87; P = .010) and shorter leukemia-free survival (LFS; hazard ratio, 1.69; P = .017). For patients with BC in remission at transplant, advanced age (≥45 years), lower performance status (≤80%), longer interval from diagnosis BC to transplant (>12 months), myeloablative conditioning, and unrelated donor (UD) transplant were risk factors for inferior survival. In patients with active BC, only UD transplant was significantly associated with prolonged LFS and trended toward improved overall survival. In summary, survival of patients allografted for BC CML was strongly dependent on pretransplant remission status. In patients with remission of BC, conventional prognostic factors remained the major determinants of outcome, whereas in those with active BC at transplant, UD transplant was associated with prolonged LFS in our study.

KEYWORDS:

Allogeneic stem cell transplantation; Blast crisis; Chronic myeloid leukemia; Outcome; Tyrosine kinase inhibitor

PMID:
31271884
DOI:
10.1016/j.bbmt.2019.06.028

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