Faculty Collaboration Database

Maintenance Tyrosine Kinase Inhibitors Following Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia: A Center for International Blood and Marrow Transplant Research Study. Biol Blood Marrow Transplant 2020 Mar;26(3):472-479

Date

11/02/2019

Pubmed ID

31669399

Pubmed Central ID

PMC7358778

DOI

10.1016/j.bbmt.2019.10.017

Scopus ID

2-s2.0-85076548681 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

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.

Author List

DeFilipp Z, Ancheta R, Liu Y, Hu ZH, Gale RP, Snyder D, Schouten HC, Kalaycio M, Hildebrandt GC, Ustun C, Daly A, Ganguly S, Inamoto Y, Litzow M, Szer J, Savoie ML, Hossain N, Kharfan-Dabaja MA, Hamadani M, Reshef R, Bajel A, Schultz KR, Gadalla S, Gerds A, Liesveld J, Juckett MB, Kamble R, Hashmi S, Abdel-Azim H, Solh M, Bacher U, Lazarus H, Olsson R, Cahn JY, Grunwald MR, Savani BN, Yared J, Rowe JM, Cerny J, Chaudhri NA, Aljurf M, Beitinjaneh A, Seo S, Nishihori T, Hsu JW, Ramanathan M, Alyea E, Popat U, Sobecks R, Saber W

Authors

Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Imatinib Mesylate
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Protein Kinase Inhibitors