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

Bone Marrow Transplantation (2019) | Download Citation

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.

Author information

Affiliations

  1. Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden

    • Anna Lübking
    • , Stig Lenhoff
    •  & Johan Richter
  2. Department of Hematology, Linköping University Hospital, Linköping, Sweden

    • Arta Dreimane
  3. Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden

    • Fredrik Sandin
  4. Department of Hematology, Umeå University Hospital, Umeå, Sweden

    • Cecilia Isaksson
    •  & Berit Märkevärn
  5. Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden

    • Mats Brune
  6. Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Section of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden

    • Per Ljungman
  7. Department of Medicine, Division of Hematology, Karolinska University Hospital Solna, Stockholm, Sweden

    • Leif Stenke
  8. Department of Medical Sciences, Division of Hematology, Uppsala University Hospital, Uppsala, Sweden

    • Martin Höglund
    •  & Ulla Olsson-Strömberg

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Contributions

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.

Conflict of interest

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.

Corresponding author

Correspondence to Anna Lübking.

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https://doi.org/10.1038/s41409-019-0513-5