Bone marrow transplantation for chronic granulocytic leukemia

Area of Science:

• Hematology
• Oncology
• Transplantation Immunology

Background:

• Chronic granulocytic leukemia (CGL) is a myeloproliferative neoplasm.
• Bone marrow transplantation (BMT) is a potential curative treatment for CGL.
• Disease phase at the time of BMT significantly impacts outcomes.

Purpose of the Study:

• To evaluate the efficacy and survival rates of BMT in CGL patients.
• To compare outcomes based on disease phase and duration before transplantation.
• To assess the role of post-transplant immunosuppression.

Main Methods:

• Thirty CGL patients received cyclophosphamide, total body irradiation (TBI), and HLA-identical BMT.
• Patients were stratified into first chronic phase (1CP) and accelerated/second chronic phase (CGLacc/CGL-2CP) groups.
• Actuarial survival and relapse rates were calculated.

Main Results:

• Actuarial survival was 63% for 1CP patients versus 27% for CGLacc/CGL-2CP patients.
• Patients transplanted within 24 months of CGL onset had 87% survival, compared to 45% for those transplanted later (P=0.04).
• No true hematologic-cytogenetic relapse occurred in 1CP patients; Ph' chromosome reappearance was transient in two patients.

Conclusions:

• BMT offers >60% survival for CGL patients in the first chronic phase.
• Outcomes are significantly worse (<30% survival) in accelerated or later disease phases due to relapse.
• Disease duration prior to transplant is a critical prognostic factor for CGL BMT success.