Table 2.
Patient | Days to ANC>500/mm3 | Days to plts>20,000/mm3 | Acute GVHD | Chronic GVHD | Other toxicity | DLI | Second generation TKI use post HSCT | Current status | F/U |
---|---|---|---|---|---|---|---|---|---|
1 | 12 | 9 | No | Yes | No | No | NiIotinib commenced at day +38 for 2weeks. Stopped due to cytopenias. Recommenced at+4 months and stopped at +7 months owing to recurrent cytopenias despite GCSF | CMR | 54 Months |
2 | 9 | 9 | No | No | Likely CMV pneumonitis | No | Dasatinib commenced day +50. Stopped after 2 weeks owing to GI side effects. | MMR | 44 Months |
3 | 17 | 8 | No | No | PTLDc | Yes Total dose: 0.52×107/kg | 1. Dasatinib started day+86, stopped after 6 weeks owing to cytopenias | MMR | 53 Months |
2. Nilotinib then used for 4 months but stopped due to cytopenias despite GCSF | |||||||||
4 | 11 | 11 | No | Yes | Idiopathic thrombocytopenic purpura | Yes Total dose: 6.81×107/kg | Nilotinib started at day+88 but stopped after 4 weeks owing to cytopenias despite GCSF | CMR | 51 Months |
5 | 18 | a | No | No | Seizures | Yes Total dose: 0.6×1 07/kg | Nilotinib started at day +74, stopped after 3 months owing to deranged LFTs | CMR | 46 Months |
6b | 1.14 2.77 | a | 1. No 2. Yesb | 1. No 2. Yesb | No | No | Dasatinib started day +56 for 5 months and stopped owing to secondary graft failure | Died | 21 Months |
7 | 14 | 12 | No | No | No | No | Nil (poor compliance) with previous TKIs | CMR | 82 Months |
8 | 11 | 16 | No | No | No | No | Nil (relapsed blast crises) | Diedd | 6 Months |
9 | 19 | 11 | Yes | Yes | PTLDc | No | Bosutinib started day+84, remains on at +8 months but poor compliance | Relapsede | 13 Months |
Abbreviations: ANC is absolute neutrophil count, GVHD is graft versus host disease, DLI is donor lymphocyte infusion, TKI is tyrosine kinase inhibitor, HSCT is haematopoietic stem cell transplant, GI is gastrointestinal, CMV is cytomegalovirus, PTLD is post transplant lymphoproliferative disorder, LFTs is liver function tests, MMR is major molecular response and CMR is complete molecular response.
Patients on LMWT heparin – thus platelet count maintained >40 with transfusion throughout cytopenic phase.
This patient received 2 times HSCT owing to secondary graft failure of initial HSCT.
Both patients with PTLD responded to single agent rituximab.
Relapsed blast crisis 3 months post HSCT (patient transplanted post second blast crisis in 3rd responsive phase).
Cytogenetic relapsed likely secondary to poor compliance with post-HSCT TKIs, initial molecular relapse unable to be controlled with DLI owing to concurrent GVHD.