Allogeneic Transplantation In Chronic Myeloid Leukemia And The Effect Of Tyrosine Kinase Inhibitors On Survival, A Quasi-Experimental Study
Journal Title: Turkish Journal of Hematology - Year 2017, Vol 34, Issue 1
Abstract
Objective: Tyrosine kinase inhibitors (TKIs) have changed the indications for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myeloid leukemia (CML). Therefore, we aimed to evaluate the effect of TKIs on allo-HSCT in CML. Materials and Methods: In this quasi-experimental study, we compared patient, disease, and transplantation characteristics as well as allo-HSCT outcomes between the pre-TKI era (before 2002) and the post-TKI era (2002 and later) in patients with CML. A total of 193 allo- HSCTs were performed between 1989 and 2012. Results: Patients in the post-TKI era had more advanced disease (>chronic phase 1) at the time of transplant and more frequently received reduced-intensity conditioning compared to patients in the pre-TKI era. Relapse/progression occurred more frequently in the year ≥2002 group than in the year <2002 group (48% vs. 32% at 5 years, p=0.01); however, overall survival (OS) was similar in these two groups (5-year survival was 50.8% vs. 59.5%, respectively; p=0.3). TKIs (with donor lymphocyte infusions or alone) for treatment of relapse after allo-HSCT were available in the post-TKI era and were associated with improved OS. While the rates of hematologic remission at 3 months after allo-HSCT were similar between TKI eras, patients having remission had better disease-free survival (DFS) [relative risk (RR): 0.15, confidence interval (CI) 95%: 0.09-0.24, p<0.001] and OS (RR: 0.14, CI 95%: 0.09-0.23, p<0.001). Male allo-HSCT recipients had worse DFS (RR: 1.7, CI 95%: 1.2-2.5, p=0.007) and OS (RR: 1.7, CI 95%: 1.1-2.6, p=0.02) than females. Conclusion: TKIs are an effective option for the treatment of relapse after allo-HSCT in CML. Hematologic remission after allo-HSCT is also an important factor for survival in CML patients.
Authors and Affiliations
Mehmet Özen, Celalettin Üstün, Bengi Öztürk, Pervin Topçuoğlu, Mutlu Arat, Erden Atilla, Gülşen Bolat, Önder Arslan, Taner Demirer, Hamdi Akan, Osman İlhan, Meral Beksaç, Günhan Gürman, Muhit Özcan
Keywords
Related Articles
- EP ID EP223909
- DOI 10.4274/tjh.2015.0346
- Views 89
- Downloads 0
Chediak-Higashi Sendromunun Hızlanmış Fazı: Hematolojik Değerlendirmenin Önemi
High Infection-Related Mortality in Pediatric Acute Myeloid Leukemia without Preventive Antibiotics and Antifungals: Retrospective Cohort Study of a Single Center from a Middle-Income Country
Objective: This study aimed to evaluate infection-related mortality in patients with acute myeloid leukemia (AML) treated without preventive antibiotics and antifungals in a middle-income country. Materials and Methods:...
Karbamazepin ve Hematolojik Maligniteler
Bir Lösemi Hastasında Bacillus pantothenticus ile Multipl Karaciğer ve Kas Abseleri
Synchronous Nodal Involvement of Metastatic Adenocarcinoma and Classical Hodgkin’s Lymphoma
To the Editor,