TY - JOUR
T1 - Reduced intensity conditioning is superior to nonmyeloablative conditioning for older chronic myelogenous leukemia patients undergoing hematopoietic cell transplant during the tyrosine kinase inhibitor era
AU - Warlick, Erica
AU - Ahn, Kwang Woo
AU - Pedersen, Tanya L.
AU - Artz, Andrew
AU - De Lima, Marcos
AU - Pulsipher, Michael
AU - Akpek, Gorgun
AU - Aljurf, Mahmoud
AU - Cahn, Jean Yves
AU - Cairo, Mitchell
AU - Chen, Yi Bin
AU - Cooper, Brenda
AU - Deol, Abhinav
AU - Giralt, Sergio
AU - Gupta, Vikas
AU - Khoury, H. Jean
AU - Kohrt, Holbrook
AU - Lazarus, Hillard M.
AU - Lewis, Ian
AU - Olsson, Richard
AU - Pidala, Joseph
AU - Savani, Bipin N.
AU - Seftel, Matthew
AU - Socié, Gerard
AU - Tallman, Martin
AU - Ustun, Celaettin
AU - Vij, Ravi
AU - Vindeløv, Lars
AU - Weisdorf, Daniel
PY - 2012/4/19
Y1 - 2012/4/19
N2 - Tyrosine kinase inhibitors (TKIs) and reduced intensity conditioning (RIC)/non-myeloablative (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/NMAHCT 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.
AB - Tyrosine kinase inhibitors (TKIs) and reduced intensity conditioning (RIC)/non-myeloablative (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/NMAHCT 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.
UR - http://www.scopus.com/inward/record.url?scp=84860338610&partnerID=8YFLogxK
U2 - 10.1182/blood-2012-02-409763
DO - 10.1182/blood-2012-02-409763
M3 - Article
C2 - 22408257
AN - SCOPUS:84860338610
SN - 0006-4971
VL - 119
SP - 4083
EP - 4090
JO - Blood
JF - Blood
IS - 17
ER -