title: Reduced intensity conditioning is superior to nonmyeloablative conditioning for older chronic myelogenous leukemia patients undergoing hematopoietic cell transplant during the tyrosine kinase inhibitor era.
abstract: Tyrosine kinase inhibitors (TKIs) and reduced intensity conditioning (RIC)/nonmyeloablative (NMA) conditioning hematopoietic cell transplants (HCTs) have changed the therapeutic strategy for chronic myelogenous leukemia (CML) patients. We analyzed post-HCT outcomes of 306 CML patients reported to the Center for International Blood and Marrow Transplant Research aged 40 years and older undergoing RIC/NMA HCT from 2001 to 2007: 117 (38%) aged 40 to 49 years, 119 (39%) 50 to 59 years, and 70 (23%) 60 years or older. The majority (74%) had treatment with imatinib before HCT. At HCT, most patients aged 40 to 49 years were in chronic phase (CP) 1 (74%), compared with 31% aged 60 years or older. Siblings were donors for 56% aged 40 to 49 years; older cohorts had more unrelated donors. The majority received peripheral blood grafts and RIC across all age groups. 3 year overall survival (54%, 52%, and 41%), day + 100 grade II-IV acute GVHD (26%, 32%, and 32%), chronic GVHD (58%, 51%, and 43%), and 1-year treatment-related mortality (18%, 20%, and 13%) were similar across ages. The 3-year relapse incidence (36%, 43%, and 66%) and disease-free survival (35%, 32%, and 16%) were inferior in the oldest cohort. Importantly, for CP1 patients, relapse and disease-free survival were similar across age cohorts. Allogeneic RIC HCT for older patients with CML can control relapse with acceptable toxicity and survival in TKI-exposed CML, especially if still in CP1.
authors.affiliation: Division of Hematology, Oncology, and Transplant, University of Minnesota, Minneapolis, MN 55455, USA. ewarlick@umn.edu
authors.forename: Erica
authors.initials: E
authors.lastname: Warlick
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Ahn
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Pedersen
authors.forename: Andrew
authors.initials: A
authors.lastname: Artz
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Michael
authors.initials: M
authors.lastname: Pulsipher
authors.forename: Gorgun
authors.initials: G
authors.lastname: Akpek
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Mitchell
authors.initials: M
authors.lastname: Cairo
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.forename: Brenda
authors.initials: B
authors.lastname: Cooper
authors.forename: Abhinav
authors.initials: A
authors.lastname: Deol
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: H Jean
authors.initials: HJ
authors.lastname: Khoury
authors.forename: Holbrook
authors.initials: H
authors.lastname: Kohrt
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Ian
authors.initials: I
authors.lastname: Lewis
authors.forename: Richard
authors.initials: R
authors.lastname: Olsson
authors.forename: Joseph
authors.initials: J
authors.lastname: Pidala
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.forename: Matthew
authors.initials: M
authors.lastname: Seftel
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Martin
authors.initials: M
authors.lastname: Tallman
authors.forename: Celaettin
authors.initials: C
authors.lastname: Ustun
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.forename: Lars
authors.initials: L
authors.lastname: Vindeløv
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
mesh_terms: D000328:Adult; D000368:Aged; D001549:Benzamides; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control*; D010879:Piperazines / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D011743:Pyrimidines / Q000627:therapeutic use*; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases