Maintenance Tyrosine Kinase Inhibitors Following Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia: A Center for International Blood and Marrow Transplant Research Study

Zachariah DeFilipp, Richard Ancheta, Ying Liu, Zhen Huan Hu, Robert Peter Gale, David Snyder, Harry C. Schouten, Matt Kalaycio, Gerhard C. Hildebrandt, Celalettin Ustun, Andrew Daly, Siddhartha Ganguly, Yoshihiro Inamoto, Mark Litzow, Jeffrey Szer, Mary Lynn Savoie, Nasheed Hossain, Mohamed A. Kharfan-Dabaja, Mehdi Hamadani, Ran ReshefAshish Bajel, Kirk R. Schultz, Shahinaz Gadalla, Aaron Gerds, Jane Liesveld, Mark B. Juckett, Rammurti Kamble, Shahrukh Hashmi, Hisham Abdel-Azim, Melhem Solh, Ulrike Bacher, Hillard Lazarus, Richard Olsson, Jean Yves Cahn, Michael R. Grunwald, Bipin N. Savani, Jean Yared, Jacob M. Rowe, Jan Cerny, Naeem A. Chaudhri, Mahmoud Aljurf, Amer Beitinjaneh, Sachiko Seo, Taiga Nishihori, Jack W. Hsu, Muthalagu Ramanathan, Edwin Alyea, Uday Popat, Ronald Sobecks, Wael Saber

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

It remains unknown whether the administration of tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 after allogeneic hematopoietic cell transplantation (HCT) is associated with improved outcomes for patients with chronic myelogenous leukemia (CML). In this registry study, we analyzed clinical outcomes of 390 adult patients with CML who underwent transplantation between 2007 and 2014 and received maintenance TKI following HCT (n = 89) compared with no TKI maintenance (n = 301), as reported to the Center for International Blood and Marrow Transplant Research. All patients received TKI therapy before HCT. The majority of patients had a disease status of first chronic phase at HCT (n = 240; 62%). The study was conducted as a landmark analysis, excluding patients who died, relapsed, had chronic graft-versus-host disease, or were censored before day +100 following HCT. Of the 89 patients who received TKI maintenance, 77 (87%) received a single TKI and the other 12 (13%) received multiple sequential TKIs. The most common TKIs used for maintenance were dasatinib (n = 50), imatinib (n = 27), and nilotinib (n = 27). As measured from day +100, the adjusted estimates for 5-year relapse (maintenance, 35% versus no maintenance, 26%; P = .11), leukemia-free survival (maintenance, 42% versus no maintenance, 44%; P = .65), or overall survival (maintenance, 61% versus no maintenance, 57%; P = .61) did not differ significantly between patients receiving TKI maintenance or no maintenance. These results remained unchanged in multivariate analysis and were not modified by disease status before transplantation. In conclusion, our data from this day +100 landmark analysis do not demonstrate a significant impact of maintenance TKI therapy on clinical outcomes. The optimal approach to TKI administration in the post-transplantation setting in patients with CML remains undetermined.

Original languageEnglish (US)
Pages (from-to)472-479
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • Allogeneic hematopoietic cell transplantation
  • Chronic myelogenous leukemia
  • Maintenance
  • Tyrosine kinase inhibitor

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    DeFilipp, Z., Ancheta, R., Liu, Y., Hu, Z. H., Gale, R. P., Snyder, D., Schouten, H. C., Kalaycio, M., Hildebrandt, G. C., Ustun, C., Daly, A., Ganguly, S., Inamoto, Y., Litzow, M., Szer, J., Savoie, M. L., Hossain, N., Kharfan-Dabaja, M. A., Hamadani, M., ... Saber, W. (2020). Maintenance Tyrosine Kinase Inhibitors Following Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia: A Center for International Blood and Marrow Transplant Research Study. Biology of Blood and Marrow Transplantation, 26(3), 472-479. https://doi.org/10.1016/j.bbmt.2019.10.017