«FLAG» REGIMEN IS EFFECTIVE FOR CHRONIC PHASE INDUCTION FOR CHRONIC MYELOID LEUKEMIA BLAST CRISIS.
(Abstract release date: 05/21/15)
EHA Library. Romanova E. 06/12/15; 102941; PB1751
Disclosure(s): Federal North – West Medical Research Centrehematology
Ekaterina Romanova
Contributions
Contributions
Abstract
Abstract: PB1751
Type: Publication Only
Background
Only hematopoetic stem cell transplantation (HSCT) should be curative in chronic myeloid leukemia blast crisis (CML BC). It seems that few patients obtain stable second chronic phase (CP) on monotherapy with tyrosin kinase inhibitors (TKI)and then might be switched to HSCT. We suggest that more patients may benefit with high doses of cytostatics in combination with TKIs.
Aims
To evaluate whether high doses of cytostatics in combination with TKIs may allow to obtain more stable response and switch more patients to HSCT.
Methods
We studied the results of different therapeutic approaches for CML BC in 19 patients (9 females and 10 males) with median age 43 years at the moment of the BC onset (range 21 - 63). CML was initiated in BC in 4 pts, whereas other pts develop BC on TKIs therapy. Median time from CML diagnosis was 44,5 mo (range from 1,7 to 139 mo). Type of BC was myeloid in 9, lymphoid in 7 and nondifferenciated in 3 pts. Pts were treated with FLAG based regimen+TKI (n=8), low dose chemo+TKIs or mono TKI (n=11). All pts obtained monoTKIs before FLAG regimen. The therapy was intensified due to lack or loose of second CP. 8 pts had SCT. Type of SCT was 4 unrelated alloSCT, 2 related alloSCT, 2 haploidentical SCT. 5 pts after FLAG and 3 pts after low dose chemo or monoTKIs undergo SCT.
Results
Second CP was obtained in 7/ 8(87.5%) patients after FLAG and only in 3/11 (27%) pts after low dose chemotherapy induction ( p= 0,02). Moreover 3 and 2 pts after FLAG induction have CCyR and MMR, accordingly. No pts on other therapies reach CCyR. 3 patients were undergone HSCT after 1 of FLAG course. Other patients received one or more FLAG consolidation. Consolidation did not lead to stable CP. All patients had rapid increase of blast count. There are no differences in duration of response in patients with low and high dose cytostatic therapy. The median time to HSCT from BC onset was 12 mo (range from 5,6 to 94 mo). The probability of survival is higher for transplanted patients vs not transplanted patients (25% vs 15%, p 0,014). 50% patients are alive after HSCT with median overall survival time after HSCT 14,5 mo (range from 4,4 to 38 mo). Median time to HSCT in alive and dead pts was 6,6 and 12,8 mo accordingly. There were no differences in overall survival after HSCT between treatment groups.
Summary
HSCT should be the goal of treatment strategy in BC CML. FLAG regimen in combination with TKIs is effective for CP induction and allow us to switch more pts to HSCT in compare with less aggressive strategies. Intensive chemo+TKIs may be able pts to reach CCyR or even MMR, but the responses are unstable and whether pts should obtained several courses of chemo for response deepening is questionable. It seems that pts should undergo HSCT as soon as possible after CP induction.
Keyword(s): Blast crisis, Chronic myeloid leukemia
Session topic: Publication Only
Type: Publication Only
Background
Only hematopoetic stem cell transplantation (HSCT) should be curative in chronic myeloid leukemia blast crisis (CML BC). It seems that few patients obtain stable second chronic phase (CP) on monotherapy with tyrosin kinase inhibitors (TKI)and then might be switched to HSCT. We suggest that more patients may benefit with high doses of cytostatics in combination with TKIs.
Aims
To evaluate whether high doses of cytostatics in combination with TKIs may allow to obtain more stable response and switch more patients to HSCT.
Methods
We studied the results of different therapeutic approaches for CML BC in 19 patients (9 females and 10 males) with median age 43 years at the moment of the BC onset (range 21 - 63). CML was initiated in BC in 4 pts, whereas other pts develop BC on TKIs therapy. Median time from CML diagnosis was 44,5 mo (range from 1,7 to 139 mo). Type of BC was myeloid in 9, lymphoid in 7 and nondifferenciated in 3 pts. Pts were treated with FLAG based regimen+TKI (n=8), low dose chemo+TKIs or mono TKI (n=11). All pts obtained monoTKIs before FLAG regimen. The therapy was intensified due to lack or loose of second CP. 8 pts had SCT. Type of SCT was 4 unrelated alloSCT, 2 related alloSCT, 2 haploidentical SCT. 5 pts after FLAG and 3 pts after low dose chemo or monoTKIs undergo SCT.
Results
Second CP was obtained in 7/ 8(87.5%) patients after FLAG and only in 3/11 (27%) pts after low dose chemotherapy induction ( p= 0,02). Moreover 3 and 2 pts after FLAG induction have CCyR and MMR, accordingly. No pts on other therapies reach CCyR. 3 patients were undergone HSCT after 1 of FLAG course. Other patients received one or more FLAG consolidation. Consolidation did not lead to stable CP. All patients had rapid increase of blast count. There are no differences in duration of response in patients with low and high dose cytostatic therapy. The median time to HSCT from BC onset was 12 mo (range from 5,6 to 94 mo). The probability of survival is higher for transplanted patients vs not transplanted patients (25% vs 15%, p 0,014). 50% patients are alive after HSCT with median overall survival time after HSCT 14,5 mo (range from 4,4 to 38 mo). Median time to HSCT in alive and dead pts was 6,6 and 12,8 mo accordingly. There were no differences in overall survival after HSCT between treatment groups.
Summary
HSCT should be the goal of treatment strategy in BC CML. FLAG regimen in combination with TKIs is effective for CP induction and allow us to switch more pts to HSCT in compare with less aggressive strategies. Intensive chemo+TKIs may be able pts to reach CCyR or even MMR, but the responses are unstable and whether pts should obtained several courses of chemo for response deepening is questionable. It seems that pts should undergo HSCT as soon as possible after CP induction.
Keyword(s): Blast crisis, Chronic myeloid leukemia
Session topic: Publication Only
Abstract: PB1751
Type: Publication Only
Background
Only hematopoetic stem cell transplantation (HSCT) should be curative in chronic myeloid leukemia blast crisis (CML BC). It seems that few patients obtain stable second chronic phase (CP) on monotherapy with tyrosin kinase inhibitors (TKI)and then might be switched to HSCT. We suggest that more patients may benefit with high doses of cytostatics in combination with TKIs.
Aims
To evaluate whether high doses of cytostatics in combination with TKIs may allow to obtain more stable response and switch more patients to HSCT.
Methods
We studied the results of different therapeutic approaches for CML BC in 19 patients (9 females and 10 males) with median age 43 years at the moment of the BC onset (range 21 - 63). CML was initiated in BC in 4 pts, whereas other pts develop BC on TKIs therapy. Median time from CML diagnosis was 44,5 mo (range from 1,7 to 139 mo). Type of BC was myeloid in 9, lymphoid in 7 and nondifferenciated in 3 pts. Pts were treated with FLAG based regimen+TKI (n=8), low dose chemo+TKIs or mono TKI (n=11). All pts obtained monoTKIs before FLAG regimen. The therapy was intensified due to lack or loose of second CP. 8 pts had SCT. Type of SCT was 4 unrelated alloSCT, 2 related alloSCT, 2 haploidentical SCT. 5 pts after FLAG and 3 pts after low dose chemo or monoTKIs undergo SCT.
Results
Second CP was obtained in 7/ 8(87.5%) patients after FLAG and only in 3/11 (27%) pts after low dose chemotherapy induction ( p= 0,02). Moreover 3 and 2 pts after FLAG induction have CCyR and MMR, accordingly. No pts on other therapies reach CCyR. 3 patients were undergone HSCT after 1 of FLAG course. Other patients received one or more FLAG consolidation. Consolidation did not lead to stable CP. All patients had rapid increase of blast count. There are no differences in duration of response in patients with low and high dose cytostatic therapy. The median time to HSCT from BC onset was 12 mo (range from 5,6 to 94 mo). The probability of survival is higher for transplanted patients vs not transplanted patients (25% vs 15%, p 0,014). 50% patients are alive after HSCT with median overall survival time after HSCT 14,5 mo (range from 4,4 to 38 mo). Median time to HSCT in alive and dead pts was 6,6 and 12,8 mo accordingly. There were no differences in overall survival after HSCT between treatment groups.
Summary
HSCT should be the goal of treatment strategy in BC CML. FLAG regimen in combination with TKIs is effective for CP induction and allow us to switch more pts to HSCT in compare with less aggressive strategies. Intensive chemo+TKIs may be able pts to reach CCyR or even MMR, but the responses are unstable and whether pts should obtained several courses of chemo for response deepening is questionable. It seems that pts should undergo HSCT as soon as possible after CP induction.
Keyword(s): Blast crisis, Chronic myeloid leukemia
Session topic: Publication Only
Type: Publication Only
Background
Only hematopoetic stem cell transplantation (HSCT) should be curative in chronic myeloid leukemia blast crisis (CML BC). It seems that few patients obtain stable second chronic phase (CP) on monotherapy with tyrosin kinase inhibitors (TKI)and then might be switched to HSCT. We suggest that more patients may benefit with high doses of cytostatics in combination with TKIs.
Aims
To evaluate whether high doses of cytostatics in combination with TKIs may allow to obtain more stable response and switch more patients to HSCT.
Methods
We studied the results of different therapeutic approaches for CML BC in 19 patients (9 females and 10 males) with median age 43 years at the moment of the BC onset (range 21 - 63). CML was initiated in BC in 4 pts, whereas other pts develop BC on TKIs therapy. Median time from CML diagnosis was 44,5 mo (range from 1,7 to 139 mo). Type of BC was myeloid in 9, lymphoid in 7 and nondifferenciated in 3 pts. Pts were treated with FLAG based regimen+TKI (n=8), low dose chemo+TKIs or mono TKI (n=11). All pts obtained monoTKIs before FLAG regimen. The therapy was intensified due to lack or loose of second CP. 8 pts had SCT. Type of SCT was 4 unrelated alloSCT, 2 related alloSCT, 2 haploidentical SCT. 5 pts after FLAG and 3 pts after low dose chemo or monoTKIs undergo SCT.
Results
Second CP was obtained in 7/ 8(87.5%) patients after FLAG and only in 3/11 (27%) pts after low dose chemotherapy induction ( p= 0,02). Moreover 3 and 2 pts after FLAG induction have CCyR and MMR, accordingly. No pts on other therapies reach CCyR. 3 patients were undergone HSCT after 1 of FLAG course. Other patients received one or more FLAG consolidation. Consolidation did not lead to stable CP. All patients had rapid increase of blast count. There are no differences in duration of response in patients with low and high dose cytostatic therapy. The median time to HSCT from BC onset was 12 mo (range from 5,6 to 94 mo). The probability of survival is higher for transplanted patients vs not transplanted patients (25% vs 15%, p 0,014). 50% patients are alive after HSCT with median overall survival time after HSCT 14,5 mo (range from 4,4 to 38 mo). Median time to HSCT in alive and dead pts was 6,6 and 12,8 mo accordingly. There were no differences in overall survival after HSCT between treatment groups.
Summary
HSCT should be the goal of treatment strategy in BC CML. FLAG regimen in combination with TKIs is effective for CP induction and allow us to switch more pts to HSCT in compare with less aggressive strategies. Intensive chemo+TKIs may be able pts to reach CCyR or even MMR, but the responses are unstable and whether pts should obtained several courses of chemo for response deepening is questionable. It seems that pts should undergo HSCT as soon as possible after CP induction.
Keyword(s): Blast crisis, Chronic myeloid leukemia
Session topic: Publication Only
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