Tags

Type your tag names separated by a space and hit enter

A comparison of long-term outcomes of donor lymphocyte infusions and tyrosine kinase inhibitors in patients with relapsed CML after allogeneic hematopoietic cell transplantation.
Clin Lymphoma Myeloma Leuk 2014; 14(1):87-92CL

Abstract

BACKGROUND

Donor lymphocyte infusion (DLI) and tyrosine kinase inhibitors (TKIs) are the 2 standard treatment options in chronic myeloid leukemia (CML) that relapses after hematopoietic cell transplantation (HCT), but reports comparing long-term outcomes of these modalities are rare.

PATIENTS AND METHODS

A total of 46 patients were treated with either DLI (n = 28) or TKIs (n = 18) during a first relapse of CML after HCT between 1993 and 2012. The stage of relapse was the chronic phase in 37 patients and the advanced phase in 9 patients. All patients had myeloablative conditioning without T-cell depletion during HCT. The median interval between HCT and treatment for relapse was 34 (range, 2-197) months.

RESULTS

At a median follow-up of 146 and 70 months, respectively, 32% of the DLI group and 33% of the TKI group had died. Six (21%) patients initially treated with DLI received TKIs during a second relapse. In multivariable analyses, DLI was associated with inferior overall survival (OS) (hazard ratio [HR], 37.4; 95% confidence interval [CI], 2.2-625.4; P = .01), shorter failure-free survival (FFS) (HR, 21.15; 95% CI, 1.8-251; P = .02), higher cumulative incidence of failure (CIF) (HR, 19.5; 95% CI, 1.6-236.5; P = .02), and increased incidence of treatment-induced graft vs. host disease (GVHD) (68% vs. 6%; P = .001).

CONCLUSION

TKIs appear better than DLI in chronic-phase relapses after myeloablative non-T-cell-depleted HCT. Outcomes were poor in advanced-phase relapses irrespective of treatment modality.

Authors+Show Affiliations

Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Electronic address: mohamed.shanavas@uhn.ca.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Department of Pathology, University Health Network, Toronto, Ontario, Canada.Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.Allogeneic Blood and Marrow Transplantation Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24252361

Citation

Shanavas, Mohamed, et al. "A Comparison of Long-term Outcomes of Donor Lymphocyte Infusions and Tyrosine Kinase Inhibitors in Patients With Relapsed CML After Allogeneic Hematopoietic Cell Transplantation." Clinical Lymphoma, Myeloma & Leukemia, vol. 14, no. 1, 2014, pp. 87-92.
Shanavas M, Messner HA, Kamel-Reid S, et al. A comparison of long-term outcomes of donor lymphocyte infusions and tyrosine kinase inhibitors in patients with relapsed CML after allogeneic hematopoietic cell transplantation. Clin Lymphoma Myeloma Leuk. 2014;14(1):87-92.
Shanavas, M., Messner, H. A., Kamel-Reid, S., Atenafu, E. G., Gupta, V., Kuruvilla, J., ... Lipton, J. H. (2014). A comparison of long-term outcomes of donor lymphocyte infusions and tyrosine kinase inhibitors in patients with relapsed CML after allogeneic hematopoietic cell transplantation. Clinical Lymphoma, Myeloma & Leukemia, 14(1), pp. 87-92. doi:10.1016/j.clml.2013.09.010.
Shanavas M, et al. A Comparison of Long-term Outcomes of Donor Lymphocyte Infusions and Tyrosine Kinase Inhibitors in Patients With Relapsed CML After Allogeneic Hematopoietic Cell Transplantation. Clin Lymphoma Myeloma Leuk. 2014;14(1):87-92. PubMed PMID: 24252361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of long-term outcomes of donor lymphocyte infusions and tyrosine kinase inhibitors in patients with relapsed CML after allogeneic hematopoietic cell transplantation. AU - Shanavas,Mohamed, AU - Messner,Hans A, AU - Kamel-Reid,Suzanne, AU - Atenafu,Eshetu G, AU - Gupta,Vikas, AU - Kuruvilla,John, AU - Kim,Dennis Dong Hwan, AU - Uhm,Jieun, AU - Lambie,Anna, AU - Ellis,Laura, AU - Lipton,Jeffrey H, Y1 - 2013/10/01/ PY - 2013/06/17/received PY - 2013/09/09/revised PY - 2013/09/24/accepted PY - 2013/11/21/entrez PY - 2013/11/21/pubmed PY - 2014/11/2/medline KW - Chronic myeloid leukemia KW - Donor lymphocyte infusion KW - Hematopoietic cell transplantation KW - Relapse KW - Tyrosine kinase inhibitor SP - 87 EP - 92 JF - Clinical lymphoma, myeloma & leukemia JO - Clin Lymphoma Myeloma Leuk VL - 14 IS - 1 N2 - BACKGROUND: Donor lymphocyte infusion (DLI) and tyrosine kinase inhibitors (TKIs) are the 2 standard treatment options in chronic myeloid leukemia (CML) that relapses after hematopoietic cell transplantation (HCT), but reports comparing long-term outcomes of these modalities are rare. PATIENTS AND METHODS: A total of 46 patients were treated with either DLI (n = 28) or TKIs (n = 18) during a first relapse of CML after HCT between 1993 and 2012. The stage of relapse was the chronic phase in 37 patients and the advanced phase in 9 patients. All patients had myeloablative conditioning without T-cell depletion during HCT. The median interval between HCT and treatment for relapse was 34 (range, 2-197) months. RESULTS: At a median follow-up of 146 and 70 months, respectively, 32% of the DLI group and 33% of the TKI group had died. Six (21%) patients initially treated with DLI received TKIs during a second relapse. In multivariable analyses, DLI was associated with inferior overall survival (OS) (hazard ratio [HR], 37.4; 95% confidence interval [CI], 2.2-625.4; P = .01), shorter failure-free survival (FFS) (HR, 21.15; 95% CI, 1.8-251; P = .02), higher cumulative incidence of failure (CIF) (HR, 19.5; 95% CI, 1.6-236.5; P = .02), and increased incidence of treatment-induced graft vs. host disease (GVHD) (68% vs. 6%; P = .001). CONCLUSION: TKIs appear better than DLI in chronic-phase relapses after myeloablative non-T-cell-depleted HCT. Outcomes were poor in advanced-phase relapses irrespective of treatment modality. SN - 2152-2669 UR - https://www.unboundmedicine.com/medline/citation/24252361/A_comparison_of_long_term_outcomes_of_donor_lymphocyte_infusions_and_tyrosine_kinase_inhibitors_in_patients_with_relapsed_CML_after_allogeneic_hematopoietic_cell_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2152-2650(13)00431-X DB - PRIME DP - Unbound Medicine ER -