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Published on: April 1, 2015
Bone marrow transplantation for patients with chronic myeloid leukemia
Insights
High-dose chemoradiotherapy with allogeneic bone marrow transplantation offers the best cure probability for chronic myeloid leukemia (CML) patients in the chronic phase. Early transplantation significantly improves survival rates and reduces relapse risk.
Area of Science:
- Hematology
- Oncology
- Transplantation Immunology
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm.
- Allogeneic bone marrow transplantation (BMT) is a potential curative therapy for CML.
- Optimal timing and conditioning regimens for BMT in CML remain critical.
Purpose of the Study:
- To evaluate the efficacy of high-dose chemoradiotherapy followed by allogeneic BMT in CML patients.
- To assess the impact of disease phase on transplantation outcomes.
- To investigate the role of T-cell depletion and splenic irradiation in preventing graft-versus-host disease (GVHD).
Main Methods:
- Treatment of 70 CML patients (52 chronic phase, 18 advanced) with high-dose chemoradiotherapy and HLA-identical sibling allogeneic BMT.
- Splenic irradiation administered to 40 patients without prior splenectomy.
- GVHD prophylaxis using cyclosporine alone or with T-cell depleted donor marrow.
Main Results:
- In the chronic phase group, 38 of 52 patients survived at a median follow-up of 25 months, with a 2-year actuarial survival of 72% and relapse risk of 7%.
- In the advanced disease group, 4 of 18 patients survived, with a 2-year actuarial survival of 18% and relapse risk of 42%.
- T-cell depletion may have reduced GVHD incidence and severity.
Conclusions:
- Allogeneic BMT following high-dose chemoradiotherapy provides the highest probability of cure for CML patients when performed during the chronic phase.
- Early transplantation in the chronic phase is associated with significantly better survival and lower relapse rates.
- The benefit of splenic irradiation requires further investigation; T-cell depletion shows promise for GVHD management.
Abstract:
Between February 1981 and December 1984 we treated 52 patients with chronic myeloid leukemia in the chronic phase and 18 patients with more advanced disease by high-dose chemoradiotherapy followed by allogeneic bone marrow transplantation using marrow cells from HLA-identical sibling donors. In addition, the 40 patients who had not previously undergone splenectomy received radiotherapy to the spleen. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with donor marrow depleted of T cells. Of the 52 patients treated in the chronic phase, 38 are alive after a median follow-up of 25 months (range, 7 to 50); the actuarial survival at two years was 72 percent, and the actuarial risk of relapse was 7 percent. Of the 18 patients with more advanced disease, 4 have survived; the actuarial two-year survival was 18 percent, and the actuarial risk of relapse was 42 percent. We conclude that the probability of cure is highest if transplantation is performed while the patient remains in the chronic phase of chronic myeloid leukemia. T-cell depletion may have reduced the incidence and severity of graft versus host disease. The value of irradiation to the spleen before transplantation has not been established.
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