Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation · 2019
Maintenance Tyrosine Kinase Inhibitors Following Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia: A Center for International Blood and Marrow Transplant Research Study.
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DeFilipp Zachariah, Ancheta Richard, Liu Ying, Hu Zhen-Huan, Gale Robert Peter, Snyder David, Schouten Harry C, Kalaycio Matt, Hildebrandt Gerhard C, Ustun Celalettin, Daly Andrew, Ganguly Siddhartha, Inamoto Yoshihiro, Litzow Mark, Szer Jeffrey, Savoie Mary Lynn, Hossain Nasheed, Kharfan-Dabaja Mohamed A, Hamadani Mehdi, Reshef Ran, Bajel Ashish, Schultz Kirk R, Gadalla Shahinaz, Gerds Aaron, Liesveld Jane, Juckett Mark B, Kamble Rammurti, Hashmi Shahrukh, Abdel-Azim Hisham, Solh Melhem, Bacher Ulrike, Lazarus Hillard, Olsson Richard, Cahn Jean-Yves, Grunwald Michael R, Savani Bipin N, Yared Jean, Rowe Jacob M, Cerny Jan, Chaudhri Naeem A, Aljurf Mahmoud, Beitinjaneh Amer, Seo Sachiko, Nishihori Taiga, Hsu Jack W, Ramanathan Muthalagu, Alyea Edwin, Popat Uday, Sobecks Ronald, Saber Wael
Аннотация
It remains unknown whether the administration of tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 after allogeneic hematopoietic cell transplantation (HCT) is associated with improved outcomes for patients with chronic myelogenous leukemia (CML). In this registry study, we analyzed clinical outcomes of 390 adult patients with CML who underwent transplantation between 2007 and 2014 and received maintenance TKI following HCT (n = 89) compared with no TKI maintenance (n = 301), as reported to the Center for International Blood and Marrow Transplant Research. All patients received TKI therapy before HCT. The majority of patients had a disease status of first chronic phase at HCT (n = 240; 62%). The study was conducted as a landmark analysis, excluding patients who died, relapsed, had chronic graft-versus-host disease, or were censored before day +100 following HCT. Of the 89 patients who received TKI maintenance, 77 (87%) received a single TKI and the other 12 (13%) received multiple sequential TKIs. The most common TKIs used for maintenance were dasatinib (n = 50), imatinib (n = 27), and nilotinib (n = 27). As measured from day +100, the adjusted estimates for 5-year relapse (maintenance, 35% versus no maintenance, 26%; P = .11), leukemia-free survival (maintenance, 42% versus no maintenance, 44%; P = .65), or overall survival (maintenance, 61% versus no maintenance, 57%; P = .61) did not differ significantly between patients receiving TKI maintenance or no maintenance. These results remained unchanged in multivariate analysis and were not modified by disease status before transplantation. In conclusion, our data from this day +100 landmark analysis do not demonstrate a significant impact of maintenance TKI therapy on clinical outcomes. The optimal approach to TKI administration in the post-transplantation setting in patients with CML remains undetermined.