Allogeneic stem cell transplantation for chronic myeloid leukemia in the TKI era: population-based data from the Swedish CML registry

Abstract

Two decades after the introduction of tyrosine kinase inhibitors (TKI), a sizeable portion of patients with chronic myeloid leukemia (CML) in chronic phase (CP) still undergo allogeneic stem cell transplantation (allo-HSCT). We investigated the indications for allo-HSCT, clinical outcome, management of relapse, and post-transplant TKI treatment in a population-based setting using the Swedish CML registry. Of 118 CML patients transplanted between 2002 and 2017, 56 (47.4%) received allo-HSCT in first CP, among whom TKI resistance was the most common transplant indication (62.5%). For patients diagnosed with CML in CP at <65 years of age, the cumulative probability of undergoing allo-HSCT within 5 years was 9.7%. Overall 5-year survival was 96.2%, 70.1% and 36.9% when transplanted in first CP, second or later CP, and in accelerated phase or blast crisis, respectively. Risk factors for relapse were EBMT score >2 and reduced intensity conditioning, and for death, CP > 2 at time point of allo-HSCT only. Non-relapse mortality for patients transplanted in CP was 11.6%. Our data indicate that allo-HSCT still constitutes a reasonable therapeutic option for patients with CML in first CP, especially those resistant to TKI treatment, providing high long-term survival and low non-relapse mortality.

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Acknowledgements

We thank all Swedish hematologists and study nurses who have reported patients to the Swedish CML registry. We also appreciate the work of data managers at the respective Regional Cancer Centers.

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UOS, AL, AD, JR, LS, MH and SL contributed to the conception and design of the study. UOS and AL coordinated the project, analyzed the data and wrote the manuscript. UOS, AL, AD, CI, BM, MB, and PL contributed to the collection and assembly of data. FS contributed to analysis, statistical methodology and manuscript writing. All authors contributed to critical revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Anna Lübking.

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UOS has received honoraria from Ariad. JR has received honoraria and research funding from Novartis and Bristol-Myers Squibb, and honoraria from Ariad. AL, AD, BM, CI, LS, FS, MB, MH, PL and SL report no disclosures.

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Lübking, A., Dreimane, A., Sandin, F. et al. Allogeneic stem cell transplantation for chronic myeloid leukemia in the TKI era: population-based data from the Swedish CML registry. Bone Marrow Transplant 54, 1764–1774 (2019). https://doi.org/10.1038/s41409-019-0513-5

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