The evolution of treatment strategies for patients with chronic myeloid leukemia relapsing after allogeneic bone marrow transplant: can tyrosine kinase inhibitors replace donor lymphocyte infusions?

Abstract

The optimal treatment for chronic myeloid leukemia (CML) relapsing following allogeneic bone marrow transplant (alloBMT) is unknown. We performed a single-center retrospective analysis of 71 consecutive patients undergoing alloBMT for CML from 1995 to 2008. A multi-state model was used to quantify cumulative incidences of complete molecular response (CMR) and death following alloBMT. The primary analysis was comparison of three treatment interventions (tyrosine kinase inhibitor: TKI, donor lymphocyte infusion: DLI, and TKI + DLI) for relapsed disease post-alloBMT. Forty-five (63%) patients relapsed post-alloBMT (molecular relapse: n = 16, cytogenetic relapse: n = 20, hematologic relapse: n = 2, advanced phase relapse: n = 7) and 40 patients underwent one of three treatments: TKI-only (n = 13), DLI-only (n = 11) or TKI + DLI (n = 16). Although not statistically significant, the TKI-only group had the highest cumulative incidence of CMR and lowest cumulative incidence of death compared to DLI and TKI + DLI. These data support the finding that TKI therapy is active in the post-alloBMT setting.

Keywords::

• Chronic myeloid leukemia
• relapse
• allogeneic transplant

Acknowledgments

We would like to thank the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center nursing and research staff for their superb medical care, and the patients and their families, from whom we have learned valuable information, to help us improve the treatment for these diseases. We would also like to thank Dr. Michael Schweizer for his invaluable support in creating the figures.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.