Risk assessment in patients with Ph+ chronic myelogenous leukemia at first relapse after allogeneic stem cell transplant: an EBMT retrospective analysis. The Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
Patients with Ph+ chronic myelogenous leukemia who relapse after a first allogeneic stem cell transplant still have a possibility of long-term survival. To assess the value of the individual therapeutic options, the factors predicting outcome should be identified. We investigated data from 500 patients who relapsed before July 1996; follow-up was updated during 1998. The actuarial survival from relapse was 34.2% (95% confidence interval [CI]: 29. 9%-38.5%) at 5 years and 23.4% (95% CI: 18.9%-27.9%) at 10 years. Survival after relapse was significantly related to 5 factors: time from diagnosis to transplant (< 2 years vs >/= 2 years), disease phase at transplant (first chronic phase vs other), disease stage at relapse (cytogenetic or chronic phase vs advanced phase), time from transplant to relapse (< 1 year vs >/= 1 year), and donor type (HLA-identical sibling vs volunteer unrelated donor). The effects of individual adverse risk factors were cumulative: The probability of survival at 10 years decreased stepwise from 42% (0 factors), 32% (1 factor), 14% (2 factors), 3% (3 factors), to 0% (4 or 5 factors). Novel strategies for high-risk patients are warranted. We conclude that these 5 factors should be taken into account when comparing results of salvage therapies in patients with Ph+ chronic myeloid leukemia relapsing after allogeneic stem cell transplant.
Guglielmi
C
C
Università "La Sapienza," Dipartimento di Biotecnologie Cellulari ed Ematologia, Unità TMO Allogenico "Giuseppe Papa," Roma, Italy.
Arcese
W
W
Hermans
J
J
Bacigalupo
A
A
Bandini
G
G
Bunjes
D
D
Carreras
E
E
Devergie
A
A
Frassoni
F
F
Goldman
J
J
Gratwohl
A
A
Kolb
H J
HJ
Iori
A P
AP
Niederwieser
D
D
Prentice
H G
HG
de Witte
T
T
Apperley
J
J
D000206:Actuarial Analysis; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008212:Lymphocyte Depletion; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014184:Transplantation, Homologous