Second Generation Tyrosine Kinase Inhibitors Combined With Allogeneic Hematopoietic Stem Cell Transplantation Improve the Prognosis of Patients with Chronic Myelogenous Leukemia in Blast Crisis

Abstract

The prognosis for patients with Chronic Myelogenous Leukemia (CML) in Blastic Crisis (BC) is poor, with a median survival of only 3-6 months. Blast crisis (BC) is highly refractory to therapy and has a poor prognosis. To determine the efficacy of TKIs-II combined with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in CML BC, we present four consecutive, recent cases of CML BC in which TKIs-II were used before or after allo-HSCT. Patient 1, a 28-year-old male received a HSCT from a half-matched, related-donor. Patient 2, 3 received an HLAidentical unrelated-donor HSCT. To date, patients 1,2,3 and 4 have survived postprocedure for 22, 23, 21 and 25 months, respectively. We conclude that compared with imatinib, TKIs-II may reduce tumor burden more rapidly and thoroughly when administered before or after allo-HSCT and enhance the graft versus leukemia effect, prolonging the long-term survival of patients. We speculate that GVL and tumor burden are negatively correlated.