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Risk factors for outcome after allogeneic stem cell transplantation in patients with advanced phase CML
Niederwieser, C., Morozova, E., Zubarovskaya, L., Zabelina, T., Klyuchnikov, E., Janson, D., Wolschke, C., Christopeit, M., Ayuk, F., Moiseev, I., et al
Bone marrow transplantation. 2021
Abstract
Allogeneic hematopoietic stem-cell transplantation (HSCT) remains the only curative option for patients with advanced chronic myeloid leukemia (CML). However, outcome is dismal and of short follow-up. The objective of the study was to determine long-term outcome and risk factors in patients with a history of CML Blast Crisis (BC; n?=?96) or accelerated phase (n?=?51) transplanted between 1990 and 2018. At transplant, patients had a median age of 39 (range 7-76) years and were in =CP2 (n?=?70), in AP (n?=?40) or in BC (n?=?37) with a diagnosis-HSCT interval of median 1.9 (range 0.3-24.4) years. Overall survival (OS) amounted 34% (95% CI 22-46) and progression-free survival (PFS) 26% (95% CI 16-36) at 15 years. Adverse risk factors for OS and PFS were low CD34(+) count in the graft, donor age (>36 years) and BC. Cumulative incidence of Non-Relapse Mortality (NRM) was 28% (95% CI 18-38) and of relapse (RI) 43% (95% CI 33-53) at 15 years. PB-HSCT and HSCT after 2008 were favorable prognostic factors for NRM, while family donor and patient age >39 years were independently associated with higher RI. HSCT resulted in long-term OS in patients with advanced CML. OS was improved in non-BC patients, with donors =36 years and with higher CD34(+) dose in the graft.