Post-transplant maintenance tyrosine kinase inhibitor (TKI) therapy is feasible and may decrease disease relapses and improve outcomes in patients with high-risk Philadelphia chromosome-positive (Ph+) leukemia following allogeneic hematopoietic cell transplantation (HCT), a study published in Clinical Lymphoma, Myeloma & Leukemia has shown.1

Because the impact of post-transplant maintenance TKIs on outcomes in this treatment setting remain unclear, researchers sought to conduct a retrospective analysis to evaluate maintenance post-transplant therapy with imatinib, dasatinib, nilotinib, or ponatinib.

For the study, researchers analyzed data from 26 allograft recipients with accelerated or blast phase chronic myeloid leukemia (CML) or Ph+ acute lymphoblastic leukemia (ALL) who received post-transplant maintenance TKI therapy with imatinib, dasatinib, nilotinib, or ponatinib between 2004 and 2014.

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Particular TKI selection was based on pretransplant TKI response, anticipated toxicities, and the presence of ABL1 domain mutations. Newer generations TKIs (i.e., dasatinib, nilotinib, ponatinib) were initiated at a dose reduction of 50% or more from the standard pretransplant dosing to minimize toxicities and avoid treatment interruption.

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Results showed that TKIs were initiated at a median of 100 days following allogeneic HCT and were administered for a median of 16 months. A total of 8 patients discontinued maintenance TKI treatment due to adverse events.

Researchers found that at a median follow-up of 3.6 years, the 5-year relapse-free survival was 61%. The 3 patients who relapsed successfully received salvage therapy and remain disease-free as of this analysis. The 5-year overall survival rate was 78%.


  1. DeFilipp Z, Langston AA, Chen Z, et al. Does post-transplant maintenance therapy with tyrosine kinase inhibitors improve outcomes of high-risk Philadelphia chromosome-positive leukemia? [published online ahead of print May 5, 2016]. Clin Lymphoma Myeloma Leuk. doi: 10.1016/j.clml.2016.04.017.