Clinical impact of pretransplant use of multiple tyrosine kinase inhibitors on the outcome of allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia |
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| Authors: | Takeshi Kondo Tokiko Nagamura‐Inoue Arinobu Tojo Fumitaka Nagamura Naoyuki Uchida Hirohisa Nakamae Takahiro Fukuda Takehiko Mori Shingo Yano Mineo Kurokawa Hironori Ueno Heiwa Kanamori Hisako Hashimoto Makoto Onizuka Minoko Takanashi Tatsuo Ichinohe Yoshiko Atsuta Kazuteru Ohashi |
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| Affiliation: | 1. Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan;2. Department of Cell Processing/Transfusion, The Institute of Medical Science, Tokyo University, Tokyo, Japan;3. Department of Hematology and Oncology, The Institute of Medical Science, Tokyo University, Tokyo, Japan;4. Center for Translational Research, The Institute of Medical Science, Tokyo University, Tokyo, Japan;5. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan;6. Department of Hematology, Osaka City University Hospital, Osaka, Japan;7. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan;8. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan;9. Jikei University School of Medicine, Hematopoietic Cell Therapy Center, Tokyo, Japan;10. Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan;11. Department of Hematology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan;12. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan;13. Department of Hematology/Division of Stem Cell Transplantation, Kobe General Hospital/Institute of Biomedical Research and Innovation, Kobe, Japan;14. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan;15. Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan;16. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima University, Hiroshima, Japan;17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan;18. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan;19. Tokyo Metropolitan Komagome Hospital, Hematology Division, Tokyo, Japan |
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| Abstract: | Tyrosine kinase inhibitors (TKIs) are widely used to treat patients with chronic myelogenous leukemia in the chronic phase (CML‐CP), and outcomes of TKI treatment for patients with CML‐CP have been excellent. Since multiple TKIs are currently available, second‐line or third‐line TKI therapy is considered for patients who are intolerant of or resistant to the previous TKI treatment. Therefore, allogeneic hematopoietic stem cell transplantation (allo‐HSCT) is considered only for patients with disease progression or for patients after treatment failure with multiple TKIs. To reflect the current clinical situation of patients with CML‐CP, we tried to clarify whether prior TKI treatment affects the outcome of allo‐HSCT. Data from 237 patients for whom the number of pretransplant TKIs varied from one to three were used for analysis. Before allo‐HSCT, 153 patients were treated with one TKI, 49 patients were treated with two TKIs and 35 patients were treated with three TKIs. In addition to conventional risk factors, i.e., disease status at transplantation and patient's age, the use of three TKIs before transplantation was identified as a significant adverse factor for prognosis. Nonrelapse mortality rate was higher in patients treated with three TKIs than in patients treated with one or two TKIs. Our results suggest that allo‐HSCT could be considered for young patients with CML‐CP who manifest resistance to second‐line TKI therapy and who have an appropriate donor. |
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