Open AccessClinical and biological predictors of outcome following relapse of CML post-allo-SCT
Author(s) -
Natasha A. Jain,
Sawa Ito,
Xin Tian,
Roger Kurlander,
Minoo Battiwalla,
Kit Lu,
Bipin N. Savani,
Vera Malkovska,
Katy Rezvani,
Robert Q. Le,
Aarthi Shenoy,
Christopher S. Hourigan,
Keyvan Keyvanfar,
Eleftheria Koklanaris,
Jeanine Superata,
Pawel Muranski,
A. John Barrett,
Agnes S. M. Yong
Publication year - 2014
Publication title -
bone marrow transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 127
eISSN - 1476-5365
pISSN - 0268-3369
DOI - 10.1038/bmt.2014.249
Subject(s) - medicine , oncology , stem cell , cd34 , transplantation , hematopoietic stem cell transplantation , progenitor cell , myeloid leukemia , cd38 , immunology , biology , genetics
Although there are now fewer allo-SCTs performed for CML, leukemic relapse post transplant remains a persistent problem. To better define clinical and biological parameters determining postrelapse outcome, we studied 59 patients with CML relapsing after HLA-identical sibling allo-SCT between 1993 and 2008. Eighteen (30.5%) were transplanted in advanced phase and 41 (69.5%) in chronic phase. With a median follow-up from relapse of 7.9 years, 5-year post relapse survival (PRS) was 62%. Multivariate analysis found disease status at transplant, time to diagnosis of relapse from transplant and pretransplant tyrosine kinase inhibitor (TKI) use as significant factors associated with PRS. Analysis of BCR-ABL transcript expression in the hematopoietic progenitor compartment was performed in 36 patients (22 relapsed, 8 non-relapsed and 6 TKI alone controls). Patients with BCR-ABL expression in their early hematopoietic stem cell compartment (Lineage(-)CD34(+)CD38(-)CD90(+)) had worse survival irrespective of the disease status. We conclude that disease status remains the strongest clinical prognostic factor for PRS in CML following allo-SCT. The persistence of BCR-ABL expression in the progenitor cell compartment in some patients after SCT emphasizes the need to target CML-leukemia stem cells.