Chapter-20 Management of Chronic Myeloid Leukemia: Stem Cell Transplant Versus Chemotherapy

2006 ◽  
pp. 342-362
Author(s):  
VP Choudhry
Keyword(s):  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Leukemia Stem Cell

Seven Year Long Follow Up of Patient With Childhood Chronic Myeloid Leukemia Postsecond Haploidentical Stem Cell Transplant

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mansi Sachdev ◽  
Minakshi Bansal ◽  
Sohini Chakraborty ◽  
Rahul Bhargava ◽  
Vikas Dua
Keyword(s):  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Stem Cell Transplant ◽  
Cell Transplant

Prolonged Engraftment and/or Primary Graft Failure Following Allogenic Stem Cell Transplant in Patients Treated with Dasatinib.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5259-5259
Author(s):  
Stephanie S. Bauer ◽  
Jennifer C. Dykeman ◽  
Kristan M. Augustin ◽  
John F. DiPersio
Keyword(s):  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Graft Failure ◽  
Stem Cell Transplant ◽  
Blast Crisis ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Allogenic Stem Cell Transplant ◽  
Primary Graft Failure

Abstract The impact of pre-transplant dasatinib therapy on engraftment after allogenic stem cell transplant remains unknown. We report delayed engraftment in the first three consecutive chronic myeloid leukemia (CML) patients at our center who received allogenic stem cell transplant after treatment with dasatinib for imatinib mesylate resistant (CML). All the patients were enrolled on the BMS clinical trial CA180035 for accelerated or blast phase chronic myeloid leukemia resistant or intolerant to imatinib. All three patients received G-CSF 5mg/kg sc daily starting from day +1 × 3 days post transplant to achieve ANC >1000. Patient 1: 53 yr female developed lymphoid blast crisis on imatinib and was given one cycle of HyperCVAD, entered a complete molecular remission (RT-PCR/BCR-ABL fish negative) and then received 140 mg PO daily of dasatinib continuously for 100 days prior to transplant. Dasatinib was discontinued one week prior to transplant and the patient was conditioned with fractionated TBI/CY 60mg/kg × 2 and infused with 2.32× 106 CD34/kg BM from a 10/10 matched unrelated donor. Patient 2: 36 yr male with accelerated phase (CML) failed imatinib and developed myeloid blast crisis. After starting dasatinib 70mg PO BID patient remained in accelerated phase and was taken off study drug after 82 days approximately two months prior to transplant because of recurrent blast crisis requiring admission for standard anti-leukemic therapy. This patient was conditioned with BU/CY and infused with 16.2× 106 CD 34/kg PBSC from a 9/10 (C antigen mismatched) unrelated donor. Primary graft failure with recurrence of disease was documented on day 30 requiring additional investigational therapy. Patient 3: 61 yr female with accelerated phase (CML) was treated with dasatinib 70mg PO BID after progression on imatinib and was unable to continue on dasatinib after 20 weeks due to myleosuppression. Dasatinib was discontinued one month prior to transplant and no additional therapy was needed. She received single dose 550 cGy TBI/CY 60mg/kg × 2 followed by infusion of 6.9 106 CD34/kg PBSC from a HLA-matched sibling donor. Primary graft failure occurred and patient was re-infused with additional G-mobilized PBSC (5.5 × 106 CD34/kg) on day +30. Patient did not achieve neutrophil recovery until 5 days after second infusion of G-mobilized PBSC from the same donor. Although the number of patients is limited, 3/3 patients treated with dasatinib prior to allogenic transplant experienced either delayed engraftment or primary graft failure. Additional patients treated with dasatinib prior to allogenic transplant will need to be studied to confirm these observations and to provide more information on dose and duration of dasatinib therapy that may impact hematopoietic engraftment after myeloablative allogenic stem cell transplantation. Patient Characteristics Patients 1 2 3 Type of Transplant BM PB PB CD34/kg 2.32×10^6/kg 16.2×10^6/kg 6.9×10^6/kg Conditioning TBI/CY BU/CY TBI/CY Disease status at transplant CMR AP CML AP CML ANC 500 +21 +27 +30 ANC 1000 +25 +27 +38 PLTS 25 +21 Not Achieved Not Achieved PLTS 50 +25 Not Achieved Not Achieved Donor Chimerism 100% day +30 0% day +30 73% day+24/100% day+84

scholarly journals Allogeneic stem cell transplant for chronic myeloid leukemia as a still promising option in the era of the new target therapy

2012 ◽  
Vol 69 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Dragana Stamatovic ◽  
Bela Balint ◽  
Ljiljana Tukic ◽  
Marija Elez ◽  
Olivera Tarabar ◽  
...  
Keyword(s):  
Stem Cell ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Stem Cell Transplant ◽  
Target Therapy ◽  
Chronic Gvhd ◽  
Lower Probability ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Term Survival

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.

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