title: Unrelated donor bone marrow transplantation for chronic myelogenous leukemia: a decision analysis.
abstract: BACKGROUND
  Chronic myelogenous leukemia (CML) is an indolent but ultimately fatal disease. Because the natural history of CML varies and quality of life with CML may be excellent until shortly before death, deciding whether and when to pursue unrelated donor bone marrow transplantation is often difficult.
  
  
  OBJECTIVE
  To compare early transplantation, delayed transplantation, and no transplantation for patients with chronic-phase CML on the basis of discounted, quality-adjusted life expectancy.
  
  
  METHODS
  A markov model comparing different strategies was constructed. This model considers patient age, quality of life, risk aversion, and the competing risks for CML progression and transplant toxicity.
  
  
  METHODS
  Therapeutic decision at the time of diagnosis of CML.
  
  
  METHODS
  The base case is a 35-year-old patient with intermediate-prognosis CML. Younger and older patients with better and worse prognoses are also evaluated.
  
  
  METHODS
  Early transplantation, delayed transplantation, and no transplantation.
  
  
  METHODS
  Quality-adjusted, discounted life expectancy.
  
  
  RESULTS
  For patients with newly diagnosed CML, transplantation within the first year provides the greatest quality-adjusted expected survival, although this benefit decreases with increasing patient age. For a 35-year-old patient with intermediate-prognosis CML, transplantation within the first year results in 53 more discounted, quality-adjusted years of life expectancy than does no transplantation. This finding is robust even with varying baseline assumptions.
  
  
  CONCLUSIONS
  These results support the use of early unrelated donor bone marrow transplantation for most patients with CML.
authors.affiliation: Center for Outcomes and Policy Research, Dana-Farber Cancer Institute Boston, MA 02115, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lee
authors.forename: K M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: M M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: P B
authors.initials: PB
authors.lastname: McGlave
authors.forename: J M
authors.initials: JM
authors.lastname: Goldman
authors.forename: K A
authors.initials: KA
authors.lastname: Sobocinski
authors.forename: J
authors.initials: J
authors.lastname: Hegland
authors.forename: C
authors.initials: C
authors.lastname: Kollman
authors.forename: S K
authors.initials: SK
authors.lastname: Parsons
authors.forename: M C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: J C
authors.initials: JC
authors.lastname: Weeks
authors.forename: J H
authors.initials: JH
authors.lastname: Antin
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003661:Decision Support Techniques; D018450:Disease Progression; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents; D016898:Interferon-alpha