When do you stop TKI before allo-HSCT?
When do you restart them?
At low dose and then escalate?
When do you stop them?
Mojtaba Akhtari
I usually wait until day +100. I start with low dose, gradually build it up, and continue it for 12 months providing the patient remains BCR-ABL negative.
0 votes
0 thanks
Ranjit Sahoo
When to stop TKI before allo-HSCT? 2-3 weeks before transplant. When to restart TKI? Between Day 30-100. It should be avoided during GVHD/Infection. In high risk circumstances (CR2 or more, pre-transplant MRD+veity, current MRD +veity) it needs to be started as early as clinical circumstance permits. It can also be started pre-emptively in low risk situations w.r.t. BCR/ABL titres and/ or chimerism status. Intriguingly, the use of TKI in post transplant setting was associated with a lower incidence of GvHD(Leukemia. 2014;28(3):658–665). At low dose and then escalate? Yes this is the most suitable way, but need to be individualised according to the clinical circumstance. When do you stop them? This is the most controversial part. Atleast for 1 year post transplant or even more if it is not affecting the QOL significantly. Which TKI? Persistence or the reappearance of an MRD indicates the presence of an intrinsic resistance to the TKI used before SCT. Therefore, the use of a different TKI logically is more appropriate. Ponatinib? Though this is not into clinical practice in such circumstances, there are few concerns regarding its use post SCT. First, skin toxicity due to ponatinib, may mimic GvHD, and Ponatinib may further worsen the endothelial toxicity promoted by calcineurin inhibitors.
1 votes
0 thanks
Mojtaba Akhtari
I always stop TKIs right before conditioning gets started. I usually wait until day +100 when I repeat the patient's bone marrow aspiration and biopsy and check chimerism. I also check BCR-ABL by PCR at that time. I start TKIs with low dose, gradually build the dose up, and continue them for 12 months providing the patient remains BCR-ABL negative.
2 votes
0 thanks
- Badges
- Science topic
- Similar topics
- Biological Science
- Molecular Cell Biology
- Culture Cells
- Cell Line
More Antonio di stasi's questions See All
Similar questions and discussions