Background/Aim. Introducing tyrosine kinase inhibitors (TKIs) has essentially
changed curative approach, to be precise, clearly improved treatment
efficacy for chronic myeloid leukemia (CML). Thus, the place and usage of
allogeneic stem cell transplant (SCT) in CML treatment - as a former "nearly
monopolistic" therapeutic manner - is nowadays controversial. The objective
of this retrospective study was to evaluate the results obtained in the
treatment of CML patients, with a particular attempt to define parameters
critical for clinical benefit and superior overall outcome following
allogeneic SCT. Methods. A total of 32 CML patients (27 in chronic phase and
5 with advanced disease), with female/male ratio 11/21, aged from 9 to 54
(32 in average) years, underwent allogeneic SCTs (1993 to 2009). The initial
treatment for 25 patients was interferon alpha (IFN-?) with or without
ARA-C, and additional 7 patients with no response to imatinib mesylat (IM).
The time from diagnosis to SCT was approximately 12 (range 3- 37) months.
The patient were categorized according to the risk for the disease,
transplant-related mortality (TRM) scoring system, and stem cell (SC)
source. The basic conditioning regimen was a combination of busulphan and
cyclophosphamide (BuCy-2). Graft-versus-host disease (GvHD) was typically
prevented with cyclosporine-A (CsA) and methotrexate (MTX). Results.
Engraftment was observed in 26 (84.4%) patients, with polymorphonuclear
(PMNs) and platelet (Plt) recovery on the 15th (range 10-22) and 19th (range
11-29) posttranspalnt days, respectively. Acute GvHD (aGvHD) had 13/26
(50%), and chronic GvHD (cGvHD) 10/21 (47.1%) patients. The incidence of
overall TRM was 46.8% (15/32), while early death was noticed in 4 (12.5%)
patients. A cause of death in 9 (28.1%) patients was cGvHD, in 2 (6.25%)
patients infection, and in 3 (9.35%) cases disease-relapse was occurred.
Fourteen (43.7%) of the patients are still alive, 9 from the low-risk group
for TRM, with long-term survival from 1 to 16 years. Patients who received
SCs from peripheral blood (PB) vs bone marrow (BM) had significantly faster
engraftment (p < 0.05), lower oropharingeal mucositis rate (25% vs 70%; p <
0.05), but more frequent cGvHD (83.3% vs 30.3%; p < 0.05). A significantly
improved (log-rank = 2.39; p < 0.01) overall survival (OS) was obtained in
BM-setting. Conclusion. The results obtained in this study are in accordance
with data from analogous clinical trials. Exactly, in the era of the new
target therapy (TKI application), allogeneic SCT can be still a convenient
therapeutic approach for well-selected CMLpatients, especially for those
with initial high-risk disease and lower probability of TRM.
Busulfan and Fludarabine As Conditioning Regimen for Unrelated Allogeneic Stem Cell Transplant: A Single-Center Experience
