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Outcome of patients with CML after SCT in the era of tyrosine kinase inhibitors

Bone Marrow Transplantation volume 47, page 304 (2012)Cite this article

In this journal, Venepalli et al.1 reviewed the role of allo-SCT in CML in the era of tyrosine kinase inhibitors (TKIs). Unfortunately, due to the availability of first- and second-generation TKIs, allo-SCT is performed too late in most patients needing a transplant. Prognostic scores can be helpful in early identification of patients for whom allo-SCT is advantageous. However, one score was evaluated only retrospectively on data from 80 patients and therefore requires prospective validation.2 Landmark analyses of response parameters to nilotinib or dasatinib after imatinib resistance have been used to provisionally define patients with suboptimal response or resistance to second-line TKI therapy.3

The role of allo-SCT in CML should be reevaluated. Whereas drug treatment has been shown to be superior in first-line treatment,4 data on allo-SCT as second-line therapy after imatinib failure are scarce. The German CML Study Group presented results of CML patients transplanted in CP with or without prior imatinib failure or intolerance within CML Study IV.5 We reported on 84 patients consecutively transplanted: 19 patients (23%) received elective transplantation in first CP, 37 patients (44%) were transplanted after imatinib failure in first CP and 28 patients (33%) were transplanted in advanced disease, including 25 patients in blast crisis and three patients in accelerated phase; 11 of these patients achieved a second and one a third CP before allo-SCT. The three-year survival rate after transplantation of 56 patients in CP was 91%, with a TRM of 8%. In a matched-pair comparison of transplanted and non-transplanted patients, survival was not different. Three-year survival after transplantation of 28 patients in advanced phase was 59%.

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References

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Authors and Affiliations

  1. Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany

    S Saußele & R Hehlmann

  2. Universitätsklinikum Basel, Basel, Switzerland

    A Gratwohl

  3. Universitätsklinikum Jena, Jena, Germany

    A Hochhaus

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  1. S Saußele
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  2. R Hehlmann
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  4. A Hochhaus
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Correspondence to S Saußele.

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Saußele, S., Hehlmann, R., Gratwohl, A. et al. Outcome of patients with CML after SCT in the era of tyrosine kinase inhibitors. Bone Marrow Transplant 47, 304 (2012). https://doi.org/10.1038/bmt.2011.70

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