Outcome of allotransplants in patients with chronic-phase chronic myeloid leukemia following imatinib failure: prognosis revisited.

Background: The outcome of allotransplants in patients with chronic -phase (CP) chronic myeloid leukemia (CML) who progressed to accelerated phase (AP) or blast phase (BP) following imatinib failure, especially those without preceding suboptimal response, remains unclear. Patients and Methods: One hundred and five patients with newly-diagnosed CML-CP were retrospectively reviewed. Sixty-six patients received first-line imatinib therapy, 26 received interferon followed by imatinib, and 13 received front-line allotransplants. Results: No significant differences were found in overall survival (p=0.57) and blast-free survival (p=025) between different first-line therapies. Among 66 imatinib-treated patients, 18 (27.3%) developed imatinib failure, 14 (21.2%) progressed to AP/BP, including eight without preceding suboptimal response. Compared to front-line allotransplant, patients with imatinib failure had a significantly worse overall survival after allotransplants (p=0.015), mainly due to an increase of treatment-related mortality. Conclusion: Early recognition of imatinib-treated patients who should receive an allotransplant is important rather than waiting until imatinib failure with disease progression.