title: Allogeneic stem cell transplantation for patients with chronic myeloid leukemia: risk stratified approach with a long-term follow-up.
abstract: The use of allogeneic stem cell transplantation (SCT) for chronic myeloid leukemia (CML) was almost abandoned in recent years for very effective targeted therapy with tyrosine kinase inhibitors (TKIs). However, approximately one third of patients still need another treatment including SCT. 38 consecutive CML patients were treated (most in preimatinib era) with allogeneic SCT, using partial T cell depletion (TCD) and preemptive donor lymphocyte infusion (DLI), without post-transplant graft-versus-host disease (GvHD) prophylaxis. Conditioning included busulfan, cyclophosphamide, antithymocytic globulin, and fludarabine followed by donor stem cell transfusion. With a median follow up of 90.5 months (1-134), 32 patients are alive. 97% engrafted. 5-year leukemia free survival (LFS) and overall survival (OS) were 78.95% and 84.2%, respectively. All patients are in major molecular remission and 78% in complete molecular remission. Transplant-related mortality (TRM) was 13%. Twenty-four patients received DLI for residual disease. Acute GvHD, mostly Grades I-II, occurred in 18% of patients post-transplant and in 24% of patients receiving DLI. In conclusion, the risk-adapted approach using only partial TCD and preemptive escalated dose of DLI precluded the need for immunosuppressive medications and reduced the risk of significant GvHD without compromising engraftment and long-term disease control. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.
authors: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel. t_zuckerman@rambam.health.gov.il
authors: Tsila
authors: T
authors: Zuckerman
authors: Tamar
authors: T
authors: Katz
authors: Nuhad
authors: N
authors: Haddad
authors: Riva
authors: R
authors: Fineman
authors: Eldad J
authors: EJ
authors: Dann
authors: Irit
authors: I
authors: Avivi
authors: Yishai
authors: Y
authors: Ofran
authors: Israel
authors: I
authors: Gavish
authors: Tal
authors: T
authors: Faibish
authors: Dvora
authors: D
authors: Sahar
authors: Eti
authors: E
authors: Hertz
authors: Edmond
authors: E
authors: Sabo
authors: Yair
authors: Y
authors: Reisner
authors: Jacob M
authors: JM
authors: Rowe
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008212:Lymphocyte Depletion / Q000379:methods; D017710:Lymphocyte Transfusion / Q000379:methods; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012306:Risk; D013601:T-Lymphocytes / Q000187:drug effects; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents