title: 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.
abstract: 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.
authors.affiliation: Università "La Sapienza," Dipartimento di Biotecnologie Cellulari ed Ematologia, Unità TMO Allogenico "Giuseppe Papa," Roma, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Guglielmi
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.forename: J
authors.initials: J
authors.lastname: Hermans
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: G
authors.initials: G
authors.lastname: Bandini
authors.forename: D
authors.initials: D
authors.lastname: Bunjes
authors.forename: E
authors.initials: E
authors.lastname: Carreras
authors.forename: A
authors.initials: A
authors.lastname: Devergie
authors.forename: F
authors.initials: F
authors.lastname: Frassoni
authors.forename: J
authors.initials: J
authors.lastname: Goldman
authors.forename: A
authors.initials: A
authors.lastname: Gratwohl
authors.forename: H J
authors.initials: HJ
authors.lastname: Kolb
authors.forename: A P
authors.initials: AP
authors.lastname: Iori
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
authors.forename: H G
authors.initials: HG
authors.lastname: Prentice
authors.forename: T
authors.initials: T
authors.lastname: de Witte
authors.forename: J
authors.initials: J
authors.lastname: Apperley
mesh_terms: 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