International journal of hematology · 2026
Allogeneic transplantation outcomes in chronic myeloid leukemia in the era of tyrosine kinase inhibitors.
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Wernicke German Jose, Enrico Alicia I, Cattaneo Maximiliano, Bendek Del Prete Georgina Emilia, Pelayes Tortosa Sofía, De Luca Teofilo, Bentolila Gonzalo, Castro Martin, Castellanos Leandro Roberto, Saslavsky Martin, Rivas María Marta, Vitriu Adriana, Arbelbide Jorge Alberto, Perez Mariel Ana, Berro Mariano, Basquiera Ana Lisa
Аннотация
BACKGROUND: Allogeneic hematopoietic cell transplantation (allo-HCT) remains relevant for selected patients with chronic myeloid leukemia (CML) in the tyrosine kinase inhibitor (TKI) era.
METHODS: We retrospectively evaluated consecutive adults initially diagnosed with chronic-phase CML who underwent first allo-HCT in Argentina between 2010 and 2023 after receiving at least one TKI. All were in first or second chronic phase at transplantation.
RESULTS: Eighty patients were included; median age was 41.7 years, 53.7% had prior blast phase (BP), and 67.5% received HLA-matched grafts. Among 71 evaluable patients, 43.7% had no pretransplant molecular response (MR). After a median follow-up of 58.4 months, 5-year overall survival (OS) and progression-free survival were 52.1% and 47.7%. OS was lower with prior BP than without prior BP (35.4% vs. 73.1%; p < 0.001) and without pretransplant MR than with any MR (38.5% vs. 59.4%; p = 0.022). Prior BP, absence of MR, and HLA mismatch were independently associated with inferior OS. Among patients with prior BP, post-transplant TKI maintenance was associated with higher OS. The 1-year non-relapse mortality and relapse rates were 17.7% and 20.1%, respectively.
CONCLUSION: Allo-HCT provides durable disease control in selected patients with CML. The find potential survival benefit of maintenance therapy requires prospective validation.
METHODS: We retrospectively evaluated consecutive adults initially diagnosed with chronic-phase CML who underwent first allo-HCT in Argentina between 2010 and 2023 after receiving at least one TKI. All were in first or second chronic phase at transplantation.
RESULTS: Eighty patients were included; median age was 41.7 years, 53.7% had prior blast phase (BP), and 67.5% received HLA-matched grafts. Among 71 evaluable patients, 43.7% had no pretransplant molecular response (MR). After a median follow-up of 58.4 months, 5-year overall survival (OS) and progression-free survival were 52.1% and 47.7%. OS was lower with prior BP than without prior BP (35.4% vs. 73.1%; p < 0.001) and without pretransplant MR than with any MR (38.5% vs. 59.4%; p = 0.022). Prior BP, absence of MR, and HLA mismatch were independently associated with inferior OS. Among patients with prior BP, post-transplant TKI maintenance was associated with higher OS. The 1-year non-relapse mortality and relapse rates were 17.7% and 20.1%, respectively.
CONCLUSION: Allo-HCT provides durable disease control in selected patients with CML. The find potential survival benefit of maintenance therapy requires prospective validation.