Allogeneic Transplantation in Chronic Myeloid Leukemia and the Effect of Tyrosine Kinase Inhibitors on Survival: A Quasi-Experimental Study

作者：Ozen Mehmet; Ustun Celalettin; Ozturk Bengi; Topcuoglu Pervin; Arat Mutlu; Gunduz Mehmet; Atilla Erden; Bolat Gulsen; Arslan Onder; Demirer Taner; Akan Hamdi; Ilhan Osman; Beksac Meral; Gurman Gunhan; Ozcan Muhit^*

来源：Turkish Journal of Hematology, 2017, 34(1): 16-26.

DOI：10.4274/tjh.2015.0346

• Chronic myeloid leukemia
• Allogeneic transplantation
• Tyrosine kinase inhibitors
• Hematologic remission

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 alloHSCTs 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.

• 出版日期2017