Allogeneic hematopoietic SCT in combination with tyrosine kinase inhibitor treatment compared with TKI treatment alone in CML blast crisis

• Published in: Bone marrow transplantation (Basingstoke) Vol. 49; no. 9; pp. 1146 - 1154
• Main Authors: Jiang, H, Xu, L-P, Liu, D-H, Liu, K-Y, Chen, S-S, Jiang, B, Jiang, Q, Chen, H, Chen, Y-H, Han, W, Zhang, X-H, Wang, Y, Wang, J-Z, Wang, F-R, Qin, Y-Z, Lai, Y-Y, Huang, X-J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2014; Nature Publishing Group
• Subjects: 631/250/1904; 692/699/67/1990/283/1896; 692/700/565/1436; 692/700/565/545/576/1955; Adolescent; Adult; Analysis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blast crisis; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer; Cell Biology; Chemotherapy; Combined Modality Therapy; Complications and side effects; Enzyme inhibitors; Explosions; Female; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation - methods; Hemoglobin; Humans; Imatinib; Internal Medicine; Kinases; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical prognosis; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; original-article; Patient outcomes; Patients; Physiological aspects; Protein Kinase Inhibitors - therapeutic use; Public Health; Retrospective Studies; Stem cell transplantation; Stem Cells; Survival; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning - methods; Treatment Outcome; Tyrosine; Tyrosine kinase inhibitors; Young Adult; China; Myeloproliferative syndrome; Drug combination; Treatment; Allogeneic hematopoietic stem cell transplantation; Hematology; Tyrosine kinase inhibitor; Chronic myelogenous leukemia; Malignant hemopathy; Blast transformation; Comparative study; Cancer
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2014.146

CML treatment with tyrosine kinase inhibitors (TKIs) has improved many patients’ prognosis, but during the disease’s terminal phase, the blast crisis (CML-BC), has been disappointing. Allo-HSCT is another treatment, but survival rates are still disappointing. Currently, a combination of these two is suggested but with little evidence. This retrospective comparison reports on this combination and TKI alone for treatment of CML-BC. Of the 83 CML-BC patients, 45 received TKIs (imatinib; nilotinb or dasatinib after imatinib resistance; TKIs group) and 38 were treated with allo-HSCT after TKI (TKIs+allo-HSCT group). Treatment success was measured in terms of the hematologic, cytogenic and molecular responses, and subject outcome. Follow-up was 30–126 months or until death. Univariate and multivariate analyses determined EFS and OS predictors. Allo-HSCT significantly improved the 4-year OS (46.7 vs 9.7%, P <0.001) and EFS (47.1 vs 6.7%, P <0.001) compared to TKI treatment alone. Hemoglobin <100 g/L, non-return to chronic phase after TKI therapy and TKI treatment alone are independent adverse predictors of OS and EFS. Allo-HSCT with individualized intervention after TKI therapy is superior to TKI alone for CML-BC.