ALLOGENEIC STEM CELL TRANSPLANTATION FOR CHRONIC MYELOID LEUKEMIA IN THE TKI ERA: POPULATION BASED DATA FROM THE SWEDISH CML REGISTRY.
Author(s): ,
Anna Lübking
Affiliations:
Dept of Hematology, Oncology and Radiation Physics,Skåne University Hospital,Lund,Sweden
,
Arta Dreimane
Affiliations:
Department of Hematology,Linköping University Hospital,Linköping,Sweden
,
Fredrik Sandin
Affiliations:
Regional Cancer Center,Uppsala University Hospital,Uppsala,Sweden
,
Cecilia Isaksson
Affiliations:
Department of Hematology,Umeå University Hospital,Umeå,Sweden
,
Berit Märkevärn
Affiliations:
Department of Hematology,Umeå University Hospital,Umeå,Sweden
,
Mats Brune
Affiliations:
Department of Hematology and Coagulation,Sahlgrenska University Hospital,Göteborg,Sweden
,
Per Ljungman
Affiliations:
Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Section of Hematology, Department of Medicine Huddinge,Karolinksa Institutet,Stockholm,Sweden
,
Stig Lenhoff
Affiliations:
Department of Hematology, Oncology and Radiation Physics,Skåne University Hospital,Lund,Sweden
,
Leif Stenke
Affiliations:
Department of Medicine, Division of Hematology,Karolinska University Hospital Solna,Stockholm,Sweden
,
Marin Höglund
Affiliations:
Division of Hematology,Uppsala University Hospital,Uppsala,Sweden
,
Johan Richter
Affiliations:
Department of Hematology, Oncology and Radiation Physics,Skåne University Hospital,Lund,Sweden
Ulla Olsson Strömberg
Affiliations:
Department of Medial Sciences, Uppsala University, Uppsala and Division of Hematology,Uppsala university hospital,Uppsala,Sweden
EHA Library. Lübking A. 06/15/18; 214849; PF376
Anna Lübking
Anna Lübking
Contributions
Abstract

Abstract: PF376

Type: Poster Presentation

Presentation during EHA23: On Friday, June 15, 2018 from 17:30 - 19:00

Location: Poster area

Background
The majority of patients with chronic myeloid leukemia (CML) in chronic phase (CP), will reach a near normal life expectancy under treatment with tyrosine kinase inhibitors (TKI). Nevertheless, about 400 patients with CML undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Europe each year, of which a sizeable number in first chronic phase.

Aims
We aimed to evaluate patients undergoing allo-HSCT regarding indication, phase of disease at transplantation and outcome in a population-based manner. Furthermore, data concerning relapse rate and management of relapse in different patient groups as well as post-transplant TKI treatment were analyzed.

Methods
From the in the Swedish CML registry, covering 98% of CML cases in the country, 119 patients diagnosed with CML between 2002 and 2016 that underwent allo-HSCT between 2002 and august 2017 were identified. Additional information was collected by systematic review of patient records.

Results
Patients diagnosed with CML at age <65 years had a cumulative probability to undergo allo-HSCT within 5 years of 12.4%. In patients transplanted in CP1 (N=57, 47.9%), indications for allo-HSCT were TKI resistance (57.9%); high risk disease/ T315I mutation (21.1%); TKI intolerance (8.8%); other causes (12.3%). Of patients, transplanted in >CP1 (n=47, 39.5%), 61.7% were initially diagnosed in accelerated phase (AP) or blast crisis (BC). Of 15 patients transplanted in AP/BC, 12 were diagnosed in CP initially. When transplanted in CP1, >CP1 or AP/BC, an unrelated donor was used in 68.4%, 70.2% and 93.3% of patients. Myeloablative conditioning was used in 45.6% of patients transplanted in CP1, 76.6% in >CP1 and 53.3% in AP/BC. Median follow-up for patients alive at last control was 7.2 years. 5-year overall survival (OS) for patients transplanted in CP1, >CP1 and AP/BC was 96.3% (95% CI 91.4-100%), 69.3% (95% CI 56.5-85.1%) and 34.3% (95% CI 16.2-72.4%). [Fig1] In total, 37 of 119 patients had relapsed and 81% of relapses occurred within 2 years. Characteristics of relapse were linked to the disease phase at allo-HSCT with mainly molecular relapses in patients transplanted in CP1. In 10 of 12 relapsed patients in this group, MR3 was achieved by treatment with DLI and/or TKI. Hematological relapse occurred in 7 of 8 patients transplanted in AP/BC and 5 of these patients died due to relapse. The probability to develop GvHD of any grade was 63.9% for all patients, 50.9% when transplanted in CP1 and 80.9% in >CP1. Risk factors for death were AP/BC at time of allo-HSCT (p=<0,001) and EBMT score >2 (p=0.008). These factors were also associated with risk for relapse with p=0.007 and p=0.013. Sokal risk score, age at transplantation, time to transplantation, conditioning regimen, type of donor or time period of allo-HSCT were not significantly associated with death or relapse. At most recent follow up 29 of all 119 patients had died. Cumulative probability for non-relapse mortality (NRM)) for patients transplanted in CP1 or >CP1 compared to patients with AP/BC at time point of allo-HSCT was 11.6% and 21.4%.

Conclusion
Our population-based study demonstrates that there is still a considerable number of patients with CML in CP undergoing allo-HSCT each year. Patients transplanted in CP1 have an excellent OS, low NRM and respond to TKI and/or DLI treatment in case of relapse. We found a relatively low NRM even for patients transplanted in AP/BC but a high number of relapses, underlying the dismal OS in this group.

Session topic: 8. Chronic myeloid leukemia - Clinical

Keyword(s): Allogeneic hematopoietic stem cell transplant, Chronic myeloid leukemia, Tyrosine kinase inhibitor

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