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Letters to the Editor

All is not lost in accelerated phase/blast crisis and after tyrosine kinase inhibitors fail in chronic myeloid leukaemia: a retrospective study of allogeneic stem cell transplant outcomes in Australia and New Zealand

Bone Marrow Transplantation volume 51, pages 1400–1403 (2016)Cite this article

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Tyrosine kinase inhibitors (TKIs) such as imatinib, nilotinib and dasatinib are now well-established first-line treatments for CML with durable responses.1, 2 The role of allogeneic stem cell transplant (alloSCT) has consequently altered in the TKI era; however, it remains an important option for selected patients with TKI resistance or inadequate disease control, including some BCR-ABL mutation-mediated resistance to TKI therapy.3, 4 Controversies such as who should receive alloSCT and the optimal timing of alloSCT are now more important. This study aimed to examine the differences in outcomes and describe temporal trends in patients having alloSCT for CML after TKI failure.

Inclusion criteria for this study were an alloSCT for CML in Australia and New Zealand between 2000–2010 for recipients aged 16 years and above, recorded on the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR).5 We compared the 2005–2010 group during which time TKIs were readily available with the 2000–2004 group during which time TKIs were less available, and analysed trends in patient, disease and transplant details. Patient consent for data submission to the ABMTRR is obtained by individual participating institutions. This study was approved by the ABMTRR Steering Committee. Further information for the 2005–2010 group was asked using a customised spreadsheet questionnaire with a limited number of questions designed to not overburden the corresponding data managers at transplant centres. Less detailed data from the ABMTRR database were used for the 2000–2004 group.

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References

  1. Saussele S, Lauseker M, Müller MC, Gratwohl A, Beelen D, Bunjes DW et al2567 Allogeneic hematopoietic stem cell transplantation (HSCT) in the imatinib-era: update on the survival outcome following allogeneic HSCT after imatinib failure; results of the German CML Study IV. 56th ASH Annual Meeting and Exposition; 6–9 December 2014; San Francisco, CA, USA.

  2. Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N et al. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 2006; 355: 2408–2417.

    Article  CAS  Google Scholar 

  3. Barrett AJ, Ito S . The role of stem cell transplantation for chronic myelogenous leukaemia in the 21st century. Blood 2015; 125: 3230–3235.

    Article  CAS  Google Scholar 

  4. Jabbour E, Cortes J, Kantarjian HM, Giralt S, Jones D, Jones R et al. Allogeneic stem cell transplantation for patients with chronic myeloid leukemia and acute lymphocytic leukemia after Bcr-Abl kinase mutation-related imatinib failure. Blood 2006; 108: 1421–1423.

    Article  CAS  Google Scholar 

  5. Nivison-Smith I, Bradstock KF, Dodds AJ, Hawkins PA, Ma DD, Moore JJ et al. Hematopoietic stem cell transplantation in Australia and New Zealand, 1992-2004. Biol Blood Marrow Transplant 2007; 13: 905–912.

    Article  Google Scholar 

  6. Gratwohl A . The EBMT risk score. Bone Marrow Transplant 2012; 47: 749–756.

    Article  CAS  Google Scholar 

  7. Champlin R, de Lima M, Kebriaei P, Rondon G, Fisher T, Jabbour E et al. Nonmyeloablative allogeneic stem cell transplantation for chronic myelogenous leukaemia in the imatinib era. Clin Lymphoma Myeloma 2009; 9 (Suppl 3): S261–S265.

    Article  CAS  Google Scholar 

  8. Jabbour E, Cortes J, Santos FPS, Jones D, O’Brien S, Rondon G et al. Results of allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia patients who failed tyrosine kinase inhibitors after developing BCR-ABL1 kinase domain mutations. Blood 2011; 117: 3641–3647.

    Article  CAS  Google Scholar 

  9. Jiang H, Xu LP, Liu DH, Liu KY, Chen SS, Jiang B et al. Allogeneic hematopoietic SCT in combination with tyrosine kinase inhibitor treatment compared with TKI treatment alone in CML blast crisis. Bone Marrow Transplant 2014; 49: 1146–1154.

    Article  CAS  Google Scholar 

  10. Baccarani M, Deininger MW, Rosti G, Hochhaus A, Soverini S, Apperley JF et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia. Blood 2013; 122: 872–874.

    Article  CAS  Google Scholar 

  11. Weiden PL, Flournoy N, Thomas ED . Antileukemic effect of graft-versus-host disease in human recipients of allogeneic-marrow grafts. N Engl J Med 1979; 300: 1068–1073.

    Article  CAS  Google Scholar 

  12. Lee SJ, Kukreja M, Wang T, Giralt SA, Szer J, Arora M et al. Impact of prior imatinib mesylate on the outcome of hematopoietic cell transplantation for chronic myeloid leukaemia. Blood 2008; 112: 3500–3507.

    Article  CAS  Google Scholar 

  13. Egan DN, Beppu L, Radich JP . Patients with Philadelphia-positive leukemia with BCR-ABL kinase mutations before allogeneic transplantation predominantly relapse with the same mutation. Biol Blood Marrow Transplant 2015; 21: 184–189.

    Article  CAS  Google Scholar 

  14. Weisser M, Tischer J, Schnittger S, Schoch C, Ledderose G, Kolb HJ . A comparison of donor lymphocyte infusions or imatinib mesylate for patients with chronic myelogenous leukemia who have relapsed after allogeneic stem cell transplantation. Haematologica 2006; 91: 663–666.

    CAS  Google Scholar 

  15. Warlick E, Ahn KW, Pedersen TL, Artz A, de Lima M, Pulsipher M et al. Reduced intensity conditioning is superior to nonmyeloablative conditioning for older chronic myelogenous leukaemia patients undergoing hematopoietic cell transplant during the tyrosine kinase inhibitor era. Blood 2012; 119: 4083–4090.

    Article  CAS  Google Scholar 

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Acknowledgements

We would like to thank colleagues at the Australasian Bone Marrow Transplant Recipient Registry and at the following hospitals for responding to the data spreadsheet questionnaire: The Alfred, Auckland City Hospital, Christchurch Hospital, Royal Adelaide Hospital, Royal Brisbane and Women’s Hospital, The Royal Melbourne Hospital, Royal Prince Alfred Hospital, Royal Perth Hospital, St Vincent’s Hospital Sydney, Wellington Hospital and Westmead Hospital. We thank Jane Apperley (London) and Timothy Hughes (Australia) for helpful suggestions and critical reading of an earlier draft of the manuscript.

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Authors and Affiliations

  1. Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia

    P Kruger & J Cooney

  2. Australasian Bone Marrow Transplant Recipient Registry, Sydney, New South Wales, Australia

    I Nivison-Smith

  3. Department of Haematology, St Vincent’s Hospital, Sydney, New South Wales, Australia

    A Dodds & D Ma

  4. Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    P Bardy

  5. Department of Clinical Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia

    J Szer

  6. Department of Haematology, Bone Marrow Transplant Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia

    S Durrant

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  1. P Kruger
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  2. J Cooney
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Correspondence to P Kruger.

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Kruger, P., Cooney, J., Nivison-Smith, I. et al. All is not lost in accelerated phase/blast crisis and after tyrosine kinase inhibitors fail in chronic myeloid leukaemia: a retrospective study of allogeneic stem cell transplant outcomes in Australia and New Zealand. Bone Marrow Transplant 51, 1400–1403 (2016). https://doi.org/10.1038/bmt.2016.143

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