[Allo-geneic hematopoietic stem cell transplantation in treatment with T315I mutation of chronic myelogenous leukemia].

Abstract

OBJECTIVE:

To explore the therapeutic efficacy of allo-geneic hematopoietic stem cell transplantation (allo-HSCT) for chronic myelogenous leukemia (CML) patients with T315I mutation.

METHODS:

Retrospective analyses were conducted for 4 patients with T315I mutation of CML undergoing allo-HSCT from June 2012 to January 2014, including 2 cases in acceleration phase and 2 in chronic phase. There were 2 males and 2 females with ages from 26 to 45 years. Two patients received HLA-matched sibling allo-geneic peripheral blood stem cell transplantation (allo-PBSCT) while another 2 unrelated cord blood stem cell transplantation (UCBT). No splenomegaly was found before transplantation. One case had F317L mutation. All of them were treated with imatinib before transplantation. And the time from medication to T315I mutation was 20-35 months. All of them were conditioned with myeloablative regimen and received a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) for preventing graft-versus-host disease (GVHD).

RESULTS:

Myeloid implantation was achieved in all of them. The time of absolute neutrophil count (ANC) ≥ 0.5×10(9)/L were 10-28 days. One patient whose platelet was not implanted died from severe pulmonary infection at Day 88 post-transplantation. For 3 patients, platelet ≥ 20×10(9)/L were 15-33 days. But the marrow short tandem repeat (STR)-PCR was 100% donor type at the time of 30 days post-transplantation in all patients. One case of UCBT developed pre-implantation immune response syndrome (PES) and one acute GVHD of gradeI at Day 12 after allo-PBSCT. However both were controlled after treatment with methylprednisolone. And 1/3 evaluatable patients developed chronic GVHD. BCR/ABL transcript was detected by qualitative PCR after transplantation. And all BCR/ABL fusion genes turned negative after 30 days of transplantation. Up to the follow-up endpoint, there was no relapse except for one mortality. And the time of disease-free survival was 133, 248 and 704 days respectively.

CONCLUSIONS:

Allo-HSCT is currently the optimal treatment for T315I mutation of CML. And umbilical cord blood is an ideal donor for those patients without HLA-matched sibling donor.

• Authors: Liyu Wang, Huilan Liu, Changcheng Zheng, Baolin Tang, Xiaoyu Zhu, Wen Yao, Lei Zhang, Zimin Sun
• Journal: Zhonghua yi xue za zhi (Zhonghua Yi Xue Za Zhi) Vol. 94 Issue 40 Pg. 3150-3 (Nov 04 2014) ISSN: 0376-2491 [Print] China
• PMID: 25573310 (Publication Type: Journal Article)

Chemical References

• Benzamides
• Piperazines
• Pyrimidines
• Cyclosporine
• Imatinib Mesylate
• Fusion Proteins, bcr-abl
• Mycophenolic Acid

Topics

• Adult
• Allografts
• Benzamides
• Cord Blood Stem Cell Transplantation
• Cyclosporine
• Disease-Free Survival
• Female
• Fusion Proteins, bcr-abl
• Graft vs Host Disease
• Hematopoietic Stem Cell Transplantation
• Humans
• Imatinib Mesylate
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive
• Male
• Middle Aged
• Mutation
• Mycophenolic Acid (analogs & derivatives)
• Peripheral Blood Stem Cell Transplantation
• Piperazines
• Pyrimidines
• Retrospective Studies
• Siblings