Reduced intensity conditioning is superior to nonmyeloablative conditioning for older chronic myelogenous leukemia patients undergoing hematopoietic cell transplant during the tyrosine kinase inhibitor era

Erica Warlick, Kwang Woo Ahn, Tanya L Pedersen, Andrew Artz, Marcos de Lima, Michael Pulsipher, Gorgun Akpek, Mahmoud Aljurf, Jean-Yves Cahn, Mitchell Cairo, Yi-Bin Chen, Brenda Cooper, Abhinav Deol, Sergio Giralt, Vikas Gupta, H Jean Khoury, Holbrook Kohrt, Hillard M Lazarus, Ian Lewis, Richard OlssonJoseph Pidala, Bipin N Savani, Matthew Seftel, Gerard Socié, Martin Tallman, Celaettin Ustun, Ravi Vij, Lars Vindeløv, Daniel Weisdorf

    43 Citationer (Scopus)

    Abstract

    Tyrosine kinase inhibitors (TKIs) and reduced intensity conditioning (RIC)/nonmyeloablative (NMA) conditioning hematopoietic cell transplants (HCTs) have changed the therapeutic strategy for chronic myelogenous leukemia (CML) patients. We analyzed post-HCT outcomes of 306 CML patients reported to the Center for International Blood and Marrow Transplant Research aged 40 years and older undergoing RIC/NMA HCT from 2001 to 2007: 117 (38%) aged 40 to 49 years, 119 (39%) 50 to 59 years, and 70 (23%) 60 years or older. The majority (74%) had treatment with imatinib before HCT. At HCT, most patients aged 40 to 49 years were in chronic phase (CP) 1 (74%), compared with 31% aged 60 years or older. Siblings were donors for 56% aged 40 to 49 years; older cohorts had more unrelated donors. The majority received peripheral blood grafts and RIC across all age groups. 3 year overall survival (54%, 52%, and 41%), day + 100 grade II-IV acute GVHD (26%, 32%, and 32%), chronic GVHD (58%, 51%, and 43%), and 1-year treatment-related mortality (18%, 20%, and 13%) were similar across ages. The 3-year relapse incidence (36%, 43%, and 66%) and disease-free survival (35%, 32%, and 16%) were inferior in the oldest cohort. Importantly, for CP1 patients, relapse and disease-free survival were similar across age cohorts. Allogeneic RIC HCT for older patients with CML can control relapse with acceptable toxicity and survival in TKI-exposed CML, especially if still in CP1.
    OriginalsprogEngelsk
    TidsskriftBlood
    Vol/bind119
    Udgave nummer17
    Sider (fra-til)4083-90
    Antal sider8
    ISSN0006-4971
    DOI
    StatusUdgivet - 2012

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