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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

Radujkovic, Aleksandar; Dietrich, Sascha; Blok, Henric-Jan; Nagler, Arnon; Ayuk, Francis; Finke, Jürgen; Tischer, Johanna; Mayer, Jiri; Koc, Yener; Sorà, Federica; Passweg, Jakob; Byrne, Jenny L.; Jindra, Pavel; Veelken, Joan Hendrik; Socié, Gerard; Maertens, Johan; Schaap, Nicolaas; Stadler, Michael; Itälä-Remes, Maija; Tholouli, Eleni; Arat, Mutlu; Rocha, Vanderson; Ljungman, Per; Yakoub-Agha, Ibrahim; Kröger, Nicolaus; Chalandon, Yves; EBMT Chronic Malignancies Working Party

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 Thumbnail


Authors

Aleksandar Radujkovic

Sascha Dietrich

Henric-Jan Blok

Arnon Nagler

Francis Ayuk

Jürgen Finke

Johanna Tischer

Jiri Mayer

Yener Koc

Federica Sorà

Jakob Passweg

Jenny L. Byrne

Pavel Jindra

Joan Hendrik Veelken

Gerard Socié

Johan Maertens

Nicolaas Schaap

Michael Stadler

Maija Itälä-Remes

Eleni Tholouli

Mutlu Arat

Vanderson Rocha

Per Ljungman

Ibrahim Yakoub-Agha

Nicolaus Kröger

Yves Chalandon

EBMT Chronic Malignancies Working Party



Abstract

The prognosis of patients with blast crisis (BC) chronic myeloid leukemia (CML) is still dismal. Allogeneic stem cell transplantation (alloSCT) 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 pre-transplant prognostic factors. A total of 170 patients allografted for BC CML after tyrosine kinase inhibitor pre-treatment between 2004 and 2016 were analyzed. Prior to 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 (OS, HR 1.87, P=0.010) and shorter leukemia-free survival (LFS, HR 1.69, P=0.017). 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 towards improved OS. In summary, survival of patients allografted for BC CML was strongly dependent on the pre-transplant 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 transplantation was associated with prolonged LFS in our study.

Citation

Radujkovic, A., Dietrich, S., Blok, H., Nagler, A., Ayuk, F., Finke, J., …EBMT Chronic Malignancies Working Party. (2019). 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. Biology of Blood and Marrow Transplantation, 25(10), 2008-2016. https://doi.org/10.1016/j.bbmt.2019.06.028

Journal Article Type Article
Acceptance Date Jun 25, 2019
Online Publication Date Jul 1, 2019
Publication Date 2019-10
Deposit Date Jun 28, 2019
Publicly Available Date Mar 29, 2024
Journal Biology of Blood and Marrow Transplantation
Print ISSN 1083-8791
Electronic ISSN 1523-6536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 25
Issue 10
Pages 2008-2016
DOI https://doi.org/10.1016/j.bbmt.2019.06.028
Keywords Chronic myeloid leukemia; Allogeneic stem cell transplantation; Outcome; Blast crisis; Tyrosine kinase inhibitor
Public URL https://nottingham-repository.worktribe.com/output/2237412
Publisher URL https://www.sciencedirect.com/science/article/pii/S1083879119304124

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