ISSN 1866-8836
Клеточная терапия и трансплантация

MP-09. Characteristics and results of treatment of patients with blast crisis of chronic myeloid leukemia who did not receive allogeneic hematopoietic stem cell transplantation

Julia S. Yakovleva, Ksenia S. Tsvirko, Yulia Yu. Vlasova, Ivan S. Moiseev, Elena V. Morozova, Tatiana L. Gindina, Alexander D. Kulagin

RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia


Contact: Dr. Julia S. Yakovleva, phone: +7 (911) 907-18-95, e-mail: YakovlevaYuliyaS@yandex.ru

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

Even in the era of tyrosine kinase inhibitors (TKIs), the outcome of patients with blast crisis (BC) chronic myeloid leukemia (CML) continues to be poor with a median overall survival (OS) of less than 1 year. There is no standard approach to BC treatment. The objective of the present study was to evaluate treatment outcomes, mainly overall survival (OS), in patients with CML BC.

Patients and methods

A total of 101 patients (73% males and 27% females) with verified CML BC receiving treatment in RM Gorbacheva Research Institute were included in this retrospective cohort. Therapy efficacy was evaluated according to the European LeukemiaNet (ELN) criteria.

Results

The median age at the time of diagnosis CML was 39 (18-71) years (Table 1). 69 patients (68%) were diagnosed in the chronic phase (CP), 15 patients (15%) in the acceleration phase (AP) and 17 patients (17%) were diagnosed with de novo BC, which was myeloid-type in 12 cases (71%) and lymphoid, in 5 cases (29%). The median age at the first BC was 44 (21-76) years, with a median time of 34 (0-248) months since the diagnosis. Most (80%) BCs were myeloid, extramedullary lesions were seen in 10% of cases. The cytogenetics data at the first BC was available in 91 (92%) cases. Additional chromosomal abnormalities (ACAs) were present in 38 (41%) cases, most frequently +8 (30%), 3q26.2 rearrangement (17%), extra Ph (17%), -7 (16%), +19 (11%) and complex karyotype (50%). T315I was the most common ABL1 mutation (44%). Most patients received complex therapy regimens combining chemotherapy and TKIs (59%), in 28% cases chemotherapy-only, and in 13% cases TKIs-only regimens were used. Allogeneic hematopoietic stem cell transplantation was not performed due to progression, severity of condition, presence of significant concomitant pathology, lack of donors, patient refusal. Clinical response was evaluated in 79% of cases, with 54% of patients being resistant to 1st-line therapy, 1% of patients reaching AP, 45% of patients reaching CP (without complete hematologic response (CHR) in 6%, CHR in 94%, cytogenetic response in 31%, molecular response in 14% of cases). In 24% of cases a 2nd BC developed. The median OS from the first BC was 11 months. At the time of the last evaluation 19% of patients were alive and 81% died.

Conclusion

The outcomes of patients with CML BC remain poor, with a median OS less than 1 year. Prompt diagnosis and treatment initiation as well as timely transition to allogeneic hematopoietic stem cell transplantation are crucial to achieve a response.

Keywords

Chronic myeloid leukemia, blast crisis, tyrosine kinase inhibitors.


Table 1. Clinical characteristics of the patients

Yakovleva-tab01.jpg

AP, acceleration phase; BC, blast crisis; CP, chronic phase.

Supplement 12-3
09/30/2023

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doi 10.18620/ctt-1866-8836-2023-12-3-1-176

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