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Reduced-intensity allogeneic hematopoietic stem cell transplantation combined with imatinib has comparable event-free survival and overall survival to long-term imatinib treatment in young patients with chronic myeloid leukemia. Ann Hematol 2017. [PMID: 28624905 DOI: 10.1007/s00277-017-3021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relative merits of reduced intensity hematopoietic stem cell transplantation (RIST) for chronic myeloid leukemia (CML) in the first chronic phase (CP) in imatinib era have not been evaluated. The study was designed to compare the outcomes of combination therapy of RIST plus imatinib (RIST + IM) vs. imatinib (IM) alone for young patients with early CP (ECP) and late CP (LCP). Of the patients, 130 were non-randomly assigned to treatment with IM alone (n = 88) or RIST + IM (n = 42). The 10-year overall survival (OS) and event-free survival (EFS) were comparable between RIST + IM and IM groups. LCP, high Sokal score, and no complete cytogenetic response at 3 months were adverse prognostic factors for survival, but only the time from diagnosis to IM was an independent predictor after multivariate analysis. For ECP, IM was similar to RIST + IM, with 10-year EFS rates of 77.2 vs. 81.6% (p = 0.876) and OS rates of 93.8 vs. 87.9% (p = 0.102), respectively. For LCP, both treatments resulted in similar survival, but more patients in the imatinib group experienced events (10-year EFS 40.8 vs. 66.7%, p = 0.047). The patients with higher EBMT risk scores had an inferior survival than those with lower scores (69.2 vs. 92.9%, p = 0.04). We concluded that RIST + IM was comparable to IM in terms of OS and EFS. However, RIST + IM was more affordable than IM alone in a 10-year scale. Thus, RIST + IM could be considered as an alternative treatment option, especially when the patients have low EBMT risk scores and demand a definite cure for CML.
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Topcuoglu P, Arat M, Ozcan M, Arslan O, Ilhan O, Beksac M, Gurman G. Case-matched comparison with standard versus reduced intensity conditioning regimen in chronic myeloid leukemia patients. Ann Hematol 2011; 91:577-86. [PMID: 21971669 DOI: 10.1007/s00277-011-1349-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 09/26/2011] [Indexed: 01/01/2023]
Abstract
This retrospective case-matched study evaluated the efficacy of reduced intensity conditioning (RIC) regimen on early and late allogeneic transplant outcome in chronic myeloid leukemia (CML) patients. Twenty-eight patients conditioned with RIC regimen were matched to 56 patients who received a myeloablative conditioning (MAC) regimen. The main criteria for case matching among our CML allotransplant cohort were the Gratwohl scoring system. The median score was 2 (1-4) in each group. The pretransplant disease status was first chronic phase (CP1, n = 20), CP2 (n = 2), and advanced phase (n = 6) in RIC, and CP1 (n = 46), CP2 (n = 3), and advanced phase (n = 7) in MAC. The duration of neutropenia and thrombocytopenia was shorter in RIC than MAC. The grade and duration of mucositis were less in RIC. The need for total parenteral nutrition (21% vs. 77%, p < 0.0001) and febrile neutropenic episodes (50% vs. 95%, p < 0.0001) were observed less frequently in RIC compared with MAC-given patients. Acute or chronic graft versus host diseases (GvHD) were not affected by the intensity of conditioning regimen. The incidence of transplant-related mortality was higher in MAC (7% vs. 14%, p = 0.01). Although more relapse/progression was observed in the RIC group, the probability of 5- and 10-year leukemia-free- and overall survival were similar regardless of conditioning regimen intensity (p > 0.05). In early first CP, the pair of female donor-male recipient and the development of chronic GvHD prolonged both leukemia-free survival and overall survival in multivariate analysis. According to our single-center matched-pair analysis, the use of RIC regimens in patients with low-risk CML results with toxicities less, responses later, and relapses more frequent than the MAC regimens.
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Affiliation(s)
- Pervin Topcuoglu
- Stem Cell Transplantation Unit, Department of Hematology, Faculty of Medicine, Ankara University, Cebeci Campus, 06590 Ankara, Turkey.
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The use of imatinib mesylate as a lifesaving treatment of chronic myeloid leukemia relapse after bone marrow transplantation. J Transplant 2009; 2009:357093. [PMID: 20107580 PMCID: PMC2809434 DOI: 10.1155/2009/357093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 08/14/2009] [Indexed: 01/19/2023] Open
Abstract
We describe the
response of imatinib as lifesaving treatment of
chronic myeloid leukemia (CML) relapse in seven
patients who underwent allogeneic bone marrow
transplantation (alloBMT) at our institution
over a period of 4 years. Retrospective analysis
of their medical records revealed that a mean age at
transplant was 45.2 years. The median time to
diagnosis was 7.4 years after transplant. At
relapse, four, two, and one patients were
classified as having hematologic, major
molecular, and cytogenetic relapse, respectively.
At imatinib initiation, five had CML in a
chronic phase, while one patient was
diagnosed as having accelerated phase and blast
crisis. All these patients could be evaluated
for the therapeutic efficacy. At a mean of
follow-up of 1.9 years of therapy, all evaluable
patients achieved major molecular response
without compromising safety. Consistent with
available data, our results indicate that
imatinib is safe and effective treatment option
for patients with relapse after
BMT.
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Moeremans K, Warie H, Annemans L. Assessment of the economic value of the INTERCEPT blood system in Belgium. Transfus Med 2006; 16:17-30. [PMID: 16480436 DOI: 10.1111/j.1365-3148.2006.00644.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Emerging pathogens continue to threaten blood safety, requiring novel safety approaches. INTERCEPT Blood System for platelets (IBSP) inactivates pathogens, aiming at eliminating the risk of transmitting current and emerging pathogens. The objective was to evaluate the incremental cost-effectiveness ratio (ICER) for IBSP in Belgium. A decision model comparing a 'world with IBSP' to a 'world without IBSP' calculates lifetime costs and 'quality adjusted life years' (QALYs) following platelet transfusion in different indications. Disease-specific life expectancy and consequences of transfusion-transmitted infections were obtained from literature. Transfusion safety and costs were obtained from official sources. Hepatitis C virus-like emerging pathogen was simulated. A wide range of ICERs was observed, highly sensitive to the risk of emerging pathogen trans- mission, underlying disease and age. In the most conservative approach, ICER ranged from 3,459,201 Euro/QALY in absence of emerging pathogen to 195,364 Euro/QALY. The mean threshold of emerging infection risk for IBSP dominance (saving money and producing health gains) ranged from 1/1,079 to 1/2,858 transfusions. Considering the high value authorities appear to place on preventing accidental injury, and ICER of recent implementations in transfusion medicine (NAT: up to 2.3 million Euro per lifeyear), IBSP can be considered cost-effective, taking into account the potential risk of emerging pathogens.
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Affiliation(s)
- K Moeremans
- HEDM, Health economics and Disease Management, Brussels, Belgium.
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Savani BN, Rezvani K, Mielke S, Montero A, Kurlander R, Carter CS, Leitman S, Read EJ, Childs R, Barrett AJ. Factors associated with early molecular remission after T cell-depleted allogeneic stem cell transplantation for chronic myelogenous leukemia. Blood 2005; 107:1688-95. [PMID: 16131570 PMCID: PMC1895415 DOI: 10.1182/blood-2005-05-1897] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Eighty patients with chronic myeloid leukemia (CML) underwent T cell-depleted stem cell transplantation from an HLA-identical sibling, with add-back of donor T cells on days 30 to 45 and days 60 to 100 in patients in whom grade 2 or greater acute graft-versus-host disease (GVHD) developed. The outcomes for 54 patients with chronic-phase (CP) and 26 with advanced-phase (AP) disease were as follows: overall survival, 85% +/- 5% versus 36% +/- 10%; transplantation-related mortality (TRM), 13% +/- 5% versus 43% +/- 11%; and current leukemia-free survival, 76% +/- 6% versus 34% +/- 9%. The day-30 lymphocyte count (LC30) was strongly associated with outcome. For patients in CP with counts greater than the median of 0.30 x 10(9)/L, survival was 100% versus 70% +/- 9% (P = .003); current LFS 100% versus 56% +/- 9% (P = .002); and TRM 0% versus 26% +/- 8% (P = .006). Higher-than-median LC30 correlated significantly with molecular remission (MR) at 3, 6, and 12 months and with higher CD34 doses. Lymphocyte subset analysis performed in 20 patients available for phenotyping showed that LC30 was highly correlated with absolute CD56+CD3- natural killer cell numbers (NK30), which also predicted for survival and MR. CD34 cell dose, LC30, and NK30, but not day-30 CD3+ cell count, were highly correlated and were significant predictors of transplantation outcome. These results suggest that transplanted CD34 cell doses greater than 5 x 10(6)/kg may improve outcomes by increasing the early recovery of NK cells.
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MESH Headings
- Aged
- Female
- Flow Cytometry
- Graft vs Host Disease
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/immunology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Lymphocyte Count
- Lymphocyte Depletion
- Lymphocyte Subsets/immunology
- Male
- Middle Aged
- Monitoring, Immunologic
- Stem Cell Transplantation/adverse effects
- Stem Cell Transplantation/methods
- Stem Cell Transplantation/mortality
- Survival Analysis
- T-Lymphocytes/immunology
- Time Factors
- Transplantation, Homologous/immunology
- Treatment Outcome
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Affiliation(s)
- Bipin N Savani
- Stem Cell Allogeneic Transplantation Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bldg 10, Hatfield CRC, Bethesda, MD 20892-1202, USA
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Chang G, Orav EJ, McNamara TK, Tong MY, Antin JH. Psychosocial function after hematopoietic stem cell transplantation. PSYCHOSOMATICS 2005; 46:34-40. [PMID: 15765819 DOI: 10.1176/appi.psy.46.1.34] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors report on a prospective cohort study of patients with chronic myelogenous leukemia undergoing allogeneic hematopoietic stem cell transplantation. The purpose was to evaluate the progression of quality of life and mood, as well as patterns of alcohol consumption, a behavior with potential adverse health consequences. Of the 84 subjects who completed serial measures and other interviews at admission for hematopoietic stem cell transplantation and 6-month follow-up, 75 provided data 12 months later The main findings of this study were that quality of life improves, measures of depressive symptoms decline, and patients drink less alcohol overall. Time was the most important variable accounting for these changes.
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Affiliation(s)
- Grace Chang
- Department of Psychiatry, Brigham and Women's Hospital Boston, MA 02115, USA.
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Burton C, Marin D, Apperley J. Personalized medical treatment strategies for patients with chronic myeloid leukemia. Expert Rev Anticancer Ther 2005; 5:343-53. [PMID: 15877530 DOI: 10.1586/14737140.5.2.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Management of patients with chronic myeloid leukemia has become increasingly difficult over the last few years since there are a variety of treatment options available. The ultimate challenge is to decide the most appropriate treatment strategy for an individual patient. To facilitate this, assessment of an individual patient's disease in terms of status, tempo and response to initial treatment needs to be determined. This review article discusses the current treatment options in the management of chronic myeloid leukemia, the factors that influence management decisions and suggests how treatment for the individual patient may be tailored whilst involving the patient in the decision-making process.
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Affiliation(s)
- Catherine Burton
- Imperial College School of Medicine, Department of Haematology, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK.
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Tefferi A, Dewald GW, Litzow ML, Cortes J, Mauro MJ, Talpaz M, Kantarjian HM. Chronic myeloid leukemia: current application of cytogenetics and molecular testing for diagnosis and treatment. Mayo Clin Proc 2005; 80:390-402. [PMID: 15757021 DOI: 10.4065/80.3.390] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic myeloid leukemia provides an illustrative disease model for both molecular pathogenesis of cancer and rational drug therapy. Chronic myeloid leukemia is a clonal stem cell disease caused by an acquired somatic mutation that fuses, through chromosomal translocation, the abl and bcr genes on chromosomes 9 and 22, respectively. The bcr/abl gene product is an oncogenic protein that localizes to the cytoskeleton and displays an up-regulated tyrosine kinase activity that leads to the recruitment of downstream effectors of cell proliferation and cell survival and consequently cell transformation. Such molecular information on pathogenesis has facilitated accurate diagnosis, the development of pathogenesis-targeted drug therapy, and most recently the application of molecular techniques for monitoring minimal residual disease after successful therapy. These issues are discussed within the context of clinical practice.
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MESH Headings
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Agents/therapeutic use
- Benzamides
- Cytarabine/therapeutic use
- Genes, abl/genetics
- Humans
- Imatinib Mesylate
- In Situ Hybridization, Fluorescence
- Interferon-alpha/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Neoplasm, Residual/diagnosis
- Philadelphia Chromosome
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Stem Cell Transplantation
- Treatment Outcome
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Affiliation(s)
- Ayalew Tefferi
- Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Chang G, Orav EJ, Tong MY, Antin JH. Predictors of 1-Year Survival Assessed at the Time of Bone Marrow Transplantation. PSYCHOSOMATICS 2004; 45:378-85. [PMID: 15345782 DOI: 10.1176/appi.psy.45.5.378] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this prospective cohort study was to identify pretransplant and transplant predictors of 1-year survival after allogeneic hematopoietic stem cell transplantation (HSCT) for chronic myelogenous leukemia. Psychosocial and behavioral variables such as alcohol abuse and cigarette smoking were systematically assessed at the time of HSCT with structured diagnostic instruments. A total of 114 patients participated, with an overall 1-year survival rate of 66%. Lifetime alcohol and other substance use, cigarette smoking, depression, and quality of life prior to transplant were not found to affect 1-year survival. However, other clinical variables prior to transplant and once transplant occurred were found to predict survival.
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Affiliation(s)
- Grace Chang
- Brigham and Women's Hospital, Boston, MA, USA.
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Abstract
Imatinib mesylate, a novel, molecularly targeted agent for the treatment of chronic myeloid leukemia (CML), has expanded the management options for this disease and provided a paradigm for the treatment of other cancers. Imatinib is a potent, specific inhibitor of BCR-ABL, the constitutively active protein tyrosine kinase critical to the pathogenesis of CML. A randomized, phase III comparison of imatinib with interferon-alfa plus cytarabine as initial treatment for newly diagnosed chronic-phase CML, which demonstrated significantly higher rates of disease response with less toxicity, better quality of life, and a significantly longer progression-free survival time, provided the most persuasive data supporting a major role for imatinib. Currently, allogeneic stem cell transplantation is the only treatment modality with long-term data demonstrating curative potential in CML. An option for less than half of CML patients and associated with substantial morbidity and mortality, transplantation may still be appropriate initial therapy for certain patients. Busulfan and hydroxyurea have no demonstrable effect on disease natural history. The interferon-plus-cytarabine combination can induce durable cytogenetic remissions and was previously the CML pharmacotherapy standard of care, but it is often poorly tolerated. Imatinib is now indicated as first-line therapy for CML in all phases.
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Affiliation(s)
- Richard M Stone
- Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA.
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Recent publications in hematology oncology. Hematol Oncol 2002; 20:147-54. [PMID: 12360948 DOI: 10.1002/hon.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Thalassemia, one of the most common genetic disorders, is considered to be a global problem. Several millions of the patients suffer from severe thalassemic diseases. Stem cell transplantation is currently the only curative therapy. Bone marrow transplantation offers a high probability of cure when performed in young children. There is a higher risk as the patient becomes older, especially the high incidence of graft rejection. Modified conditioning regimens live been developed to overcome graft rejection in patients with class III or full blown manifestations. The alternative use of stem cell from cord blood makes possible earlier transplant with better chance of cure, although the engraftment is slower compared to bone marrow transplantation. More experiences with regard to stem cell transplantation in adult patients, the use of stem cell transplantation from related donors as well as matched unrelated donors are necessary.
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Affiliation(s)
- Surapol Issaragrisil
- Chulabhorn Bone Marrow Transplant Center, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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