Allogeneic bone marrow transplantation for chronic myeloid leukemia: a single center experience.
BACKGROUND
Bone marrow transplantation (BMT) is the therapy of choice for patients with chronic myeloid leukemia (CML) who have a human leukocyte antigen (HLA)-identical donor and are under 50 years of age.


METHODS
Here, 45 patients with CML were treated with busulfan (Bu) 16 mg/kg and cyclophosphamide (Cy) 120 mg/kg before allogeneic BMT from an HLA-identical sibling 27 (60%) or a 1-antigen mismatch donor 18 (40%). Eighteen patients (40%) were in the early chronic phase (CP) and 27 (60%) in late CP. We used cyclosporin-A (CsA) in 20 patients and cyclosporin-A-methotrexate (CsA-MTX) in 25 for graft-vs.-host disease (GVHD) prophylaxis.


RESULTS
We observed a high incidence of acute and chronic GVHD (69% and 67%, respectively). A multivariate analysis identified differences in the sex of the donor and the recipient (p = 0.03) and grade III-IV acute GVHD (p = 0.0001) as significant adverse influences on disease-free survival. Age, sex, chronic GVHD, disease phase, one antigen-mismatch and use of CsA or CsA-MTX had no statistical significance. The 3-year probabilities of relapse, disease-free survival, and overall survival were 11%, 55%, and 60%, respectively. Transplant-related mortality occurred in 31% of the cases. The high frequency of GVHD is explained by HLA determination by serological typing, differences in sex between the donor and recipient, and a high proportion (40%) of 1 antigen-mismatch donors.


CONCLUSIONS
BMT is a procedure feasible for patients with CML in early and late chronic phase and even in those with an HLA non-identical donor. Strategies directed to decrease acute GVHD could improve the outcome of these patients.
Vela-Ojeda
J
J
Departamento de Hematología, Programa de Trasplante de Médula Osea, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS), México, D.F., Mexico. velaj12x@df1.telmex.net.mx
Tripp-Villanueva
F
F
Sánchez-Cortés
E
E
Ayala-Sánchez
M
M
Rosas-Cabral
A
A
Esparza
M G
MG
García-Chávez
J
J
García-León
L D
LD
González-Llaven
J
J
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality; D007249:Inflammation / Q000209:etiology; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D015993:Life Tables; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010677:Philadelphia Chromosome; D011292:Premedication; D016016:Proportional Hazards Models; D012008:Recurrence; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome