TY - JOUR
T1 - Long-term follow-up of allogeneic hematopoietic stem-cell transplantation with reduced-intensity conditioning for patients with chronic myeloid leukemia
AU - Kebriaei, Partow
AU - Detry, Michelle A.
AU - Giralt, Sergio
AU - Carrasco-Yalan, Antonio
AU - Anagnostopoulos, Athanasios
AU - Couriel, Daniel
AU - Khouri, Issa F.
AU - Anderlini, Paolo
AU - Hosing, Chitra
AU - Alousi, Amin
AU - Champlin, Richard E.
AU - De Lima, Marcos
PY - 2007/11/1
Y1 - 2007/11/1
N2 - Allogeneic hematopoietic stem-cell transplantation (HSCT) remains an effective strategy for inducing durable remission in chronic myeloid leukemia (CML). Reduced-intensity conditioning (RIC) regimens extend HSCT to older patients and those with comorbidities who would otherwise not be suitable candidates for HSCT. The long-term efficacy of this approach is not established. We evaluated outcomes of 64 CML patients with advanced-phase disease (80% beyond first chronic phase), not eligible for myeloablative preparative regimens due to older age or comorbid conditions, who were treated with fludarabine-based RIC regimens. Donor type was matched related (n = 30), 1 antigen-mismatched related (n = 4), or matched unrelated (n = 30). With median follow-up of 7 years, overall survival (OS) and progression free survival (PFS) were 33% and 20%, respectively, at 5 years. Incidence of treatment-related mortality (TRM) was 33%, 39%, and 48% at 100 days, and 2 and 5 years after HSCT, respectively. In multivariate analysis, only disease stage at time of HSCT was significantly predictive for both OS and PFS. RIC HSCT provides adequate disease control in chronic-phase CML patients, but alternative treatment strategies need to be explored in patients with advanced disease. TRM rates are acceptable in this high-risk population but increase over time.
AB - Allogeneic hematopoietic stem-cell transplantation (HSCT) remains an effective strategy for inducing durable remission in chronic myeloid leukemia (CML). Reduced-intensity conditioning (RIC) regimens extend HSCT to older patients and those with comorbidities who would otherwise not be suitable candidates for HSCT. The long-term efficacy of this approach is not established. We evaluated outcomes of 64 CML patients with advanced-phase disease (80% beyond first chronic phase), not eligible for myeloablative preparative regimens due to older age or comorbid conditions, who were treated with fludarabine-based RIC regimens. Donor type was matched related (n = 30), 1 antigen-mismatched related (n = 4), or matched unrelated (n = 30). With median follow-up of 7 years, overall survival (OS) and progression free survival (PFS) were 33% and 20%, respectively, at 5 years. Incidence of treatment-related mortality (TRM) was 33%, 39%, and 48% at 100 days, and 2 and 5 years after HSCT, respectively. In multivariate analysis, only disease stage at time of HSCT was significantly predictive for both OS and PFS. RIC HSCT provides adequate disease control in chronic-phase CML patients, but alternative treatment strategies need to be explored in patients with advanced disease. TRM rates are acceptable in this high-risk population but increase over time.
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U2 - 10.1182/blood-2007-04-085969
DO - 10.1182/blood-2007-04-085969
M3 - Article
C2 - 17652620
AN - SCOPUS:36148980474
SN - 0006-4971
VL - 110
SP - 3456
EP - 3462
JO - Blood
JF - Blood
IS - 9
ER -