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Marrow transplantation for the treatment of chronic myelogenous leukemia
Insights
Marrow transplants improve survival for chronic myelogenous leukemia (CML) patients. Early transplantation and favorable disease status significantly increase long-term survival rates, with most survivors disease-free.
Area of Science:
- Hematology
- Oncology
- Transplantation Medicine
Background:
- Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm.
- Marrow transplantation is a potential curative therapy for CML.
Purpose of the Study:
- To evaluate the outcomes of marrow transplantation in patients with chronic myelogenous leukemia.
- To identify predictors of survival following marrow transplantation for CML.
Main Methods:
- Retrospective analysis of 198 patients with CML undergoing intensive chemotherapy and total body irradiation followed by marrow transplantation.
- Multivariate analysis to determine prognostic factors for survival.
Main Results:
- Disease status at transplantation was the strongest predictor of survival.
- Long-term survival rates varied by phase: 49% (1st chronic), 58% (2nd chronic), 15% (accelerated), and 14% (blastic) for allogeneic grafts.
- Survival for syngeneic grafts was 87% (chronic), 27% (accelerated), and 12% (blastic).
- Major causes of death included interstitial pneumonia (chronic phase) and relapse (accelerated/blastic phases).
- Favorable factors included early transplantation, age <30, and absence of severe graft-versus-host disease.
Conclusions:
- Marrow transplantation can achieve long-term disease-free survival in CML patients.
- Prognosis is strongly dependent on disease status at the time of transplantation.
- Early intervention and patient selection are critical for optimizing outcomes in CML marrow transplantation.
Abstract:
One hundred ninety-eight patients with chronic myelogenous leukemia received marrow transplants after intensive chemotherapy and total body irradiation. Multivariate analysis showed disease status at time of transplantation to be the most powerful predictor of survival. The probability of long-term survival for allogeneic graft recipients was 49% for 67 patients in the first chronic phase, 58% for 12 in the second chronic phase, 15% for 46 in the accelerated phase, and 14% for 42 in the blastic phase. The major cause of death was interstitial pneumonia for patients in the chronic phase, and relapse for those in the blastic or accelerated phases. Factors favoring survival were early transplantation, age less than 30 years, and absence of severe graft-versus-host disease. Splenectomy or spleen size did not influence survival. For recipients of syngeneic grafts survival probability was 87% for 16 patients in the chronic phase, 27% for 7 in the accelerated phase, and 12% for 8 in the blastic phase. Of the 198 patients, 71 are alive without Philadelphia chromosomes 1 to 9 years after receiving their graft. All but 4 long-term disease-free survivors have Karnofsky performance scores of 80% or better.
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