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Bone marrow transplantation for chronic granulocytic leukemia
Journal of the National Cancer Institute
|June 1, 1986
Summary
Bone marrow transplantation offers a potential cure for chronic granulocytic leukemia (CGL). Patients in the chronic phase showed promising results with no relapses, suggesting effective disease ablation.
Area of Science:
- Hematology
- Oncology
- Transplantation Immunology
Background:
- Chronic granulocytic leukemia (CGL) is characterized by Philadelphia chromosome-positive (Ph+) cells.
- Effective treatment strategies for CGL, particularly in advanced phases, remain a significant challenge.
Purpose of the Study:
- To evaluate the efficacy and safety of supralethal chemoradiotherapy followed by bone marrow transplantation (BMT) in patients with CGL.
- To assess outcomes based on the phase of CGL at the time of transplantation.
Main Methods:
- Supralethal chemoradiotherapy followed by HLA-identical bone marrow transplantation.
- Patient stratification based on disease phase: chronic, accelerated, or blast crisis.
- Engraftment assessment and monitoring for disease relapse and transplant-related complications.
Main Results:
- All 37 patients achieved engraftment, and the Philadelphia chromosome (Ph+) disappeared in all cases.
- Patients transplanted in the chronic phase had the best outcomes, with all 10 survivors achieving unmaintained remission (median follow-up 14 months) and no relapses.
- Outcomes were less favorable in accelerated and blast crisis phases, with higher rates of mortality and relapse.
Conclusions:
- Bone marrow transplantation is highly effective in eradicating Ph+ cells in CGL, especially when performed during the chronic phase.
- The granulocytic hyperplasia of the chronic phase is more effectively ablated than established blastic leukemia.
- BMT may offer a chance for long-term survival or cure for over half of CGL patients in the chronic phase, balancing transplant risks against disease progression.