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Long term follow up after allogeneic stem cell transplantation for chronic myelogenous leukemia
E Reiter1, H T Greinix, S Brugger
1Department of Medicine I, BMT, Institute for Medical Statistics, University of Vienna, Austria.
Insights
Bone marrow transplantation (BMT) for chronic myelogenous leukemia (CML) using sibling or unrelated donors shows high cure rates. Transplant-related mortality was acceptable, indicating BMT is a viable treatment option for CML patients.
Area of Science:
- Hematology
- Oncology
- Transplantation immunology
Background:
- Chronic myelogenous leukemia (CML) is a myeloproliferative neoplasm.
- Bone marrow transplantation (BMT) is a potential curative therapy for CML.
- Assessing outcomes of BMT from different donor types is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of allogeneic BMT in CML patients.
- To compare outcomes between sibling and unrelated donor BMT.
- To analyze survival rates and transplant-related mortality.
Main Methods:
- Retrospective analysis of 83 CML patients undergoing BMT between 1983 and 1997.
- Donors included HLA-identical siblings and matched/mismatched unrelated donors.
- Conditioning regimens and graft-versus-host disease prophylaxis varied.
Main Results:
- Durable engraftment achieved in 97% of patients.
- 58% overall survival at study end; 56% survival after sibling BMT and 63% after MUD BMT.
- Disease-free survival was 53% (sibling) and 58% (MUD); relapse rate was 12%.
Conclusions:
- Allogeneic BMT, from both sibling and unrelated donors, offers high cure rates for CML.
- Acceptable transplant-related mortality supports BMT as a treatment option.
- Outcomes vary by disease phase at transplantation.
Abstract:
Between January 1983 and July 1997, 83 patients (35 female, 48 male) with a median age of 37 (19-57) years with chronic myelogenous leukemia (CML) were admitted for bone marrow transplantation (BMT) at the University hospital of Vienna. Fifty-six patients were in chronic phase, 17 in accelerated and 10 had blast crisis. Marrow donors were: HLA-identical siblings in 62 patients, 2-antigen mismatched related donor in 2, HLA-identical unrelated donors (MUD) in 17 and 1-antigen mismatched unrelated donor in 2 patients. The median time from diagnosis to BMT was 22 (2-91) months. Conditioning therapy consisted of cyclophosphamide (CY) and total body irradiation or CY and busulfan. For graft-versus-host disease (GVHD) prophylaxis methotrexate (MTX) alone, MTX and cyclosporine A (CSA), CSA alone or CSA and methylprednisone were given. Durable engraftment was documented in 75 of 77 patients (97%). As of July 31, 1997 48 patients are alive (58%), 36 (56%) after sibling transplantation with a median observation time of 77 months and 12 (63%) after MUD transplantation with a median observation time of 13 months. Overall survival for patients in chronic phase (CP) at time of BMT is 64%, 53% for patients in acceleration and 30% for patients in blast crisis (BC). Disease-free survival (DFS) after sibling BMT and unrelated donor transplantation is 53% and 58%, respectively. Ten patients (12%) experienced relapse of CML. Transplant-related mortality was 33% after sibling and 32% after MUD transplantation. Thus, sibling and unrelated donor BMT offer high cure rates with acceptable toxicity to patients with CML.