133 Allogeneic Stem Cell Transplantation in Chronic Myeloid Leukemia in Era of Tyrosine Kinase Inhibitors -a Single Centre Experience from India (Record no. 83885)

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fixed length control field 03917nab a2200289 4500
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fixed length control field 190625b2019 xxu||||| |||| 00| 0 eng d
100 ## - MAIN ENTRY--PERSONAL NAME
Personal name Parthiban SK
245 ## - TITLE STATEMENT
Title 133 Allogeneic Stem Cell Transplantation in Chronic Myeloid Leukemia in Era of Tyrosine Kinase Inhibitors -a Single Centre Experience from India
260 ## - PUBLICATION, DISTRIBUTION, ETC. (IMPRINT)
Date of publication, distribution, etc 2019
300 ## - PHYSICAL DESCRIPTION
Extent
500 ## - GENERAL NOTE
General note Abstract published in the
520 ## - SUMMARY, ETC.
Summary, etc Background
Transplant remains most curative option for patients with TKI resistant disease or in advanced phase of CML. We retrospectively analyzed transplant outcome of CML patients in era of TKI from our centre.

Methods
All patients who underwent allogeneic stem cell transplant for CML between Aug 2010 to Sept 2016 were included. Conditioning regimens included Flu-Mel (67.5%), Bu-Cy (10%), Flu- 7.2 Gy TBI (15%), or Flu-treo-2GyTBI (7.5%). For matched sibling (MSD) or unrelated donor (MUD) transplants, GVHD prophylaxes were cyclosporine (CsA) with methotrexate in 26(65%) or mycophenolate(MMF) in 8 (20%) patients respectively . Post transplant cyclophosphamide (PtCy) with CSA / tacrolimus with MMF was used in 6 (15%) patients who underwent haploidentical transplant (HIT) .Disease Risk Index (DRI), HCT-CI and EBMT scores at transplant were calculated for all . Overall survival (OS) was calculated from date of transplant to date of death or last follow up while relapse-free survival (RFS) was calculated till date of molecular relapse (>0.1% BCR-ABL),death or LFU if in MMR. Prognostic factors evaluated were duration from diagnosis to transplant (<2 or> 2 years), EBMT score (≤3 vs>3), acute and chronic GVHD, type of transplant and DRI index.

Results
Median age was 30 years (12-55) of which 30 (75%) were male. TKI failure was the commonest reason for transplant (95%) .T315I mutation was seen in 17.5% of patients . Twenty-six (65%) were in CP, 8 in AP and 6 in BC at diagnosis. The median EBMT and HCT-CI score were 3 and 2 respectively. Twelve (30%) patients had high DRI. MSD transplant was performed in 33 (82.5%), 6 (15%) underwent HIT and 1 MUD transplant. All except 1 patient received PBSC graft. Grade III/IV mucositis and diarrhea were seen in 19 (47.5%) and 4 (10%) patients respectively. Median time to neutrophil and platelet engraftment were 16 and 13.5 days respectively. Incidence of grade III/IV acute GVHD and chronic GVHD was 50% and 60% respectively. At 1 year post transplant >4.5 log reduction (DMR) was attained in 25 (62.5%) while 5 (12.5%) patients were in MMR. Five patients received DLI (3 patients for clinical relapse,2 for slippage of chimerism). Median follow up was 36 months. Non relapse mortality was seen in 8 (20%) patients. (GVHD-7, Myocarditis1). OS and RFS at 5 years were 70 % and 57 % respectively. In multivariate analysis for RFS, EBMT score≤ 3 and time from diagnosis to transplant > 2 years were independent prognostic factors for better RFS. For OS, presence of chronic and absence of acute GVHD were independent prognostic factors for better survival.

Conclusion
The long term survival in TKI resistant and advanced CML with transplant is promising. Along with other factors, transplant after 2 years from diagnosis was an independent prognostic factor for better survival contrary to transplant within 1 year of diagnosis in the pre TKI era .This may be due to better disease control with advent of TKIs.
650 ## - SUBJECT ADDED ENTRY--TOPICAL TERM
Topical term or geographic name as entry element Stem cell transplantation
650 ## - SUBJECT ADDED ENTRY--TOPICAL TERM
Topical term or geographic name as entry element Leukemia
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Topical term or geographic name as entry element Tyrosine kinase inhibitors
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Personal name Nayak L
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Personal name Bonda A
700 ## - ADDED ENTRY--PERSONAL NAME
Personal name Bagal B
700 ## - ADDED ENTRY--PERSONAL NAME
Personal name Punatar S
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Personal name Gokarn A
700 ## - ADDED ENTRY--PERSONAL NAME
Personal name Mathew LJ
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Personal name Kannan S
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Personal name Khattry N
773 ## - HOST ITEM ENTRY
Main entry heading Biology of Blood and Marrow Transplantation
Place, publisher, and date of publication Charlottesville, VA : Carden Jennings Publishing, 2019
Relationship information Vol.25, no. S3, p. S103
International Standard Serial Number 1083-8791
906 ## - LOCAL DATA ELEMENT F, LDF (RLIN)
Dept Medical Oncology
Corporate name TMC
Article Type Conference Abstract
Country type International
Added Entry TMH
942 ## - ADDED ENTRY ELEMENTS (KOHA)
Source of classification or shelving scheme
Item type Articles
Holdings
Withdrawn status Lost status Source of classification or shelving scheme Damaged status Not for loan Permanent location Current location Date acquired Barcode Date last seen Koha item type
          Tata Memorial Hospital Tata Memorial Hospital 2019-06-25 AR19504 2019-06-25 Articles

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