Evaluating allogeneic hematopoietic cell transplantation in patients with chronic myeloid leukemia who are resistant or intolerant to tyrosine kinase inhibitors

This study aimed to investigate the effectiveness of allogeneic hematopoietic stem cell transplantation (alloHSCT) in patients with chronic-phase chronic myeloid leukemia (CP-CML) who are resistant or intolerant to tyrosine kinase inhibitor (TKI) treatment. 

This study concluded that alloHSCT is effective in these patients.  

TKI treatment is a targeted therapy that is used as the first-line treatment in patients with CP-CML. However, 15 to 20% of patients fail TKI treatment due to resistance or intolerance. Before TKIs, first-line treatment for patients with CP-CML involved alloHSCT. It involves taking cells from a donor and transplanting them to the patient. It helps to replace cells damaged by chemotherapy and boosts the immune system to fight cancer.  

Patients with CP-CML patients are eligible for alloHSCT if they fail more than one TKI and/or are intolerant to the drug. However, how effective alloHSCT is in patients with CP-CML who are resistant or intolerant to TKIs remains under investigation. 

This study analyzed data from 9 other studies involving 439 patients with CP-CML who were intolerant or resistant to TKIs. Patients were treated using alloHSCT. 

The overall survival (OS) rate was 84% for adults and 91% for children. The overall disease-free survival (DFS) rate was 66%. 56% of participants achieved complete remission (complete disappearance of cancer). The overall relapse rate was 19%.

A common complication after alloHSCT is graft versus host disease (GVHD). This is when the transplanted cells attack the patient. The short-term GVHD rate was 46% and the long-term GVHD rate was 51%.

This study concluded that alloHSCT is an effective treatment for patients with CP-CML who are resistant or intolerant to TKI treatment.  

The studies analyzed had a very small number of participants. The intensity of chemotherapy before transplant varied among studies. This may have influenced the results.