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Outcome of allogeneic SCT in patients with chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy

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Abstract

The introduction of tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) led to a dramatic change in the role of allogeneic stem cell transplantation (SCT) with a rapid decline in the number of patients receiving SCT in first chronic phase (CP1). We evaluated 68 consecutive patients in all phases of CML (male/female = 39:29, 27 in CP1), who received SCT from related/unrelated donors (related/unrelated = 23:45) under myeloablative or reduced intensity conditioning (MAC/RIC = 45:23). Forty-eight patients (71 %) received TKIs pre-SCT, 20 patients post-SCT (29 %). Overall survival (OS) of CP1 patients achieved a plateau of 85 % at 10 months. Relapse-free survival (RFS) of CP1 patients was 85 % at 1 and 2 years, and 81 % at 5 years. Multivariate analysis showed adverse OS and RFS for patients transplanted >CP1 (hazard ratio (HR) = 6.61 and 4.62) and those who had grade III–IV aGvHD (HR = 2.45 and 1.82). Patients with advanced CML had estimated OS of 65 and 47 %; and RFS of 41 and 32 % at 1 and 2 years respectively. Therefore, for patients with advanced CML phases, allogeneic SCT provides an acceptable chance of cure. Transplant research should focus on improving conditioning regimens and post-SCT management for this subgroup of CML patients.

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Acknowledgments

The authors are grateful to Gitta Amtsfeld and Marion Heinzelmann for the assistance with the clinical data. Finally, we appreciate the invaluable support of all co-workers of the Department for Stem Cell Transplantation who participated in the care of these patients.

Conflict of interest

AO received a grant from Novartis. MC received honoraria from Novartis. All other authors have nothing to declare.

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Authors and Affiliations

  1. Department for Stem Cell Transplantation, University Cancer Center Hamburg (UCCH), Martinistr. 52, 20246, Hamburg, Germany

    Anthony Oyekunle, Axel R. Zander, Francis Ayuk, Tatjana Zabelina, Thomas Stübig, Haefaa Alchalby, Heinrich Lellek, Christine Wolschke, Ingo Müller, Ulrike Bacher & Nicolaus Kröger

  2. Department of Hematology and Immunology, Obafemi Awolowo University (OAU), Ile-Ife, Nigeria

    Anthony Oyekunle

  3. Department of Oncology and Hematology, University Cancer Center Hamburg (UCCH), Hamburg, Germany

    Mascha Binder & Philippe Schafhausen

  4. Department for Oncology and Haematology, University Hospital and Medical Faculty Halle, Halle, Germany

    Maximilian Christopeit

  5. Department of Pediatric Hematology and Oncology, University of Hamburg, Hamburg, Germany

    Ingo Müller

  6. MLL Munich Leukemia Laboratory, Munich, Germany

    Ulrike Bacher

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  1. Anthony Oyekunle
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  2. Axel R. Zander
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  8. Haefaa Alchalby
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  9. Philippe Schafhausen
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  10. Heinrich Lellek
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  11. Christine Wolschke
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  12. Ingo Müller
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  13. Ulrike Bacher
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  14. Nicolaus Kröger
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Correspondence to Ulrike Bacher.

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Oyekunle, A., Zander, A.R., Binder, M. et al. Outcome of allogeneic SCT in patients with chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy. Ann Hematol 92, 487–496 (2013). https://doi.org/10.1007/s00277-012-1650-8

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