Individualized intervention guided by BCR-ABL transcript levels after HLA-identical sibling donor transplantation improves HSCT outcomes for patients with chronic myeloid leukemia.
The aim of this study was to determine the effect of individualized intervention guided by BCR-ABL transcript levels after hematopoietic stem cell transplantation (HSCT) on relapse and leukemia-free survival (LFS) of patients with chronic myelogenous leukemia (CML). Eighty-four consecutive patients who received HLA-identical sibling HSCT were enrolled. The patients were conditioned with a modified busulfan and cyclophosphamide regimen, and received stem cells from a HLA-identical sibling donor. Patients were identified as high risk of relapse based on serial monitoring of post-HSCT BCR-ABL transcript levels, and patients in the high-risk group were given individualized intervention. Interventions included immunosuppressant withdrawal, modified donor lymphocyte infusion, and imatinib mesylate. Engraftment was successful in all patients. Twenty-eight patients were categorized as high risk because of higher post-HSCT BCR-ABL transcript levels and received intervention. The 56 low-risk patients received no intervention. Twenty-five high-risk patients achieved complete molecular remission at a median of 49 days (range: 18-232 days) after intervention. Two high-risk patients and 1 low-risk patient ultimately relapsed, the 4-year relapse rate was 3.9% ± 4.4%. Overall 4-year survival was 89.0% ± 7% and the 4-year LFS was 89.2% ± 6.8%. All surviving patients remains in complete molecular remission after a median of 1481 (1040-1794) days follow-up. Individualized intervention based on the post-HSCT BCR-ABL transcript level can decrease relapse and increase LFS of patients with CML after HLA-identical sibling HSCT.
Huang
Xiao-Jun
XJ
Peking University People's Hospital, Peking University Hematology Institute, Beijing, People's Republic of China. xjhrm@medmail.com.cn
Xu
Lan-Ping
LP
Liu
Kai-Yan
KY
Liu
Dai-Hong
DH
Chen
Huan
H
Liu
Yan-Rong
YR
Chen
Yu-Hong
YH
Han
Wei
W
Wang
Yu
Y
D000293:Adolescent; D000328:Adult; D001549:Benzamides; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000032:analysis* / Q000096:biosynthesis; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006650:Histocompatibility Testing; D006801:Humans; D000068877:Imatinib Mesylate; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage; D057285:Precision Medicine / Q000379:methods*; D011505:Protein-Tyrosine Kinases / Q000032:analysis* / Q000096:biosynthesis; D011743:Pyrimidines / Q000008:administration & dosage; D012333:RNA, Messenger / Q000032:analysis; D012306:Risk; D035781:Siblings; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D001549:Benzamides; D007166:Immunosuppressive Agents; D010879:Piperazines; D011743:Pyrimidines; D012333:RNA, Messenger; D000068877:Imatinib Mesylate; D003520:Cyclophosphamide; D011505:Protein-Tyrosine Kinases; D016044:Fusion Proteins, bcr-abl; D002066:Busulfan