Bone marrow transplantation for chronic myelogenous leukemia in chronic phase. Increased risk for relapse associated with T-cell depletion.
Data on 405 patients with chronic myelogenous leukemia who received bone marrow transplants in chronic phase were analyzed for factors predictive of outcome. The 4-year actuarial probability of relapse was 19% (95% confidence interval [CI], 12% to 28%) and of survival, 55%. In multivariate analyses the probability of relapse was higher for recipients of T-cell-depleted bone marrow compared with recipients of non-T-cell-depleted bone marrow (relative risk, 5.4; P less than 0.0001) and for patients who did not develop chronic graft-versus-host disease (95% CI, 50% to 60%) with patients who did (relative risk, 3.1; P less than 0.01). The probability of survival was lower for patients who developed moderate to severe acute graft-versus-host disease than for patients with no or mild acute graft-versus-host disease (relative risk, 3.7; P less than 0.0001), and in patients aged 20 or older than in younger patients (relative risk, 2.6; P less than 0.0002). Duration of disease before transplant was not associated with outcome. Bone marrow transplantation done in the chronic phase of chronic myelogenous leukemia offers some patients prolonged leukemia-free survival. The T-cell-depleted grafts are associated with an increased probability of relapse.
Goldman
J M
JM
Department of Medicine, Medical College of Wisconsin, Milwaukee.
Gale
R P
RP
Horowitz
M M
MM
Biggs
J C
JC
Champlin
R E
RE
Gluckman
E
E
Hoffmann
R G
RG
Jacobsen
S J
SJ
Marmont
A M
AM
McGlave
P B
PB
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001854:Bone Marrow Cells; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000401:mortality / Q000628:therapy*; D008297:Male; D011336:Probability; D012008:Recurrence; D012307:Risk Factors; D013223:Statistics as Topic; D013601:T-Lymphocytes