Journal of Clinical Oncology, Vol 10, 779-789, Copyright © 1992 by American Society of Clinical Oncology

ARTICLES

Bone marrow transplantation of chronic myelogenous leukemia in chronic phase: evaluation of risks and benefits

JE Wagner, M Zahurak, S Piantadosi, RB Geller, GB Vogelsang, JR Wingard, R Saral, C Griffin, N Shah and BA Zehnbauer
Bone Marrow Transplantation Unit, Johns Hopkins Oncology Center, Johns Hopkins University School of Medicine, Baltimore, MD.

PURPOSE: Allogeneic bone marrow transplantation (BMT) is an option for some patients with chronic myelogenous leukemia (CML). We retrospectively evaluated the effect of various risk factors observed at diagnosis and at transplantation on survival, event-free survival (EFS), and relapse after BMT. PATIENTS AND METHODS: Seventy-nine patients with CML in chronic phase (CP) were treated with cyclophosphamide and total body irradiation followed by BMT. Graft- versus-host disease (GVHD) prophylaxis consisted of cyclosporine (CsA) in most instances or CsA plus the use of lymphocyte-depleted bone marrow (BM). RESULTS: Survival at 4.5 years was 52%. Stratified by age and GVHD prophylaxis, the actuarial survival was 65% (95% confidence interval [CI], 47% to 78%) in patients aged less than 30 years receiving unmanipulated BM, 33% (95% CI, 12% to 56%) in patients greater than or equal to 30 years old receiving unmanipulated BM, and 38% (95% CI, 14% to 63%) in patients greater than or equal to 30 years old receiving lymphocyte-depleted BM. In univariate analysis, patient age (greater than or equal to 30 years) and the use of lymphocyte- depleted BM negatively influenced EFS. When stratified by age and GVHD prophylaxis, however, ABO incompatibility, cytomegalovirus (CMV) seropositivity, and chronic GVHD significantly reduced the probability of EFS. Factors that have been associated with early death in nontransplanted patients (ie, sex, spleen size, blast and platelet counts at presentation) were not predictive of long-term survival outcome after BMT. CONCLUSIONS: The data suggest that (1) BMT should be offered early after diagnosis to all patients with CML in CP who have compatible sibling donors regardless of prognostic factors at presentation, (2) GVHD remains the principal cause of mortality after BMT in patients receiving CsA, and (3) T-cell depletion by the physical separation method of counterflow elutriation (CE) is associated with a significant risk of relapse.

This article has been cited by other articles:

				V. T. Ho and R. J. Soiffer The history and future of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic hematopoietic stem cell transplantation Blood, December 1, 2001; 98(12): 3192 - 3204. [Full Text] [PDF]

				E. K. Waller, H. Rosenthal, T. W. Jones, J. Peel, S. Lonial, A. Langston, I. Redei, I. Jurickova, and M. W. Boyer Larger numbers of CD4bright dendritic cells in donor bone marrow are associated with increased relapse after allogeneic bone marrow transplantation Blood, May 15, 2001; 97(10): 2948 - 2956. [Abstract] [Full Text] [PDF]

				M. L. Hensley, B. Peterson, R. T. Silver, R. A. Larson, C. A. Schiffer, and T. P. Szatrowski Risk Factors for Severe Neuropsychiatric Toxicity in Patients Receiving Interferon Alfa-2b and Low-Dose Cytarabine for Chronic Myelogenous Leukemia: Analysis of Cancer and Leukemia Group B 9013 J. Clin. Oncol., March 13, 2000; 18(6): 1301 - 1308. [Abstract] [Full Text] [PDF]

				E. K. Waller, A. M. Ship, S. Mittelstaedt, T. W. Murray, R. Carter, I. Kakhniashvili, S. Lonial, J. T. Holden, and M. W. Boyer Irradiated Donor Leukocytes Promote Engraftment of Allogeneic Bone Marrow in Major Histocompatibility Complex Mismatched Recipients Without Causing Graft-Versus-Host Disease Blood, November 1, 1999; 94(9): 3222 - 3233. [Abstract] [Full Text] [PDF]

				R. T. Silver, S. H. Woolf, R. Hehlmann, F. R. Appelbaum, J. Anderson, C. Bennett, J. M. Goldman, F. Guilhot, H. M. Kantarjian, A. E. Lichtin, et al. An Evidence-Based Analysis of the Effect of Busulfan, Hydroxyurea, Interferon, and Allogeneic Bone Marrow Transplantation in Treating the Chronic Phase of Chronic Myeloid Leukemia: Developed for the American Society of Hematology Blood, September 1, 1999; 94(5): 1517 - 1536. [Abstract] [Full Text] [PDF]