Multicenter prospective study of interferon-alpha versus bone marrow transplantation for newly diagnosed patients with chronic myelogenous leukemia: a preliminary analysis.
Interferon-alpha (IFN-alpha) therapy was compared with bone marrow transplantation (BMT) in patients with chronic myelogenous leukemia (CML) in a multicenter, prospective study. Of 254 evaluable patients, 175 received IFN-alpha and 79 received allogeneic BMT, 50 of whom received transplants from human leukocyte antigen (HLA)-identical related donors and 29 from HLA-matched unrelated donors. Complete hematologic response was achieved by 148 patients (89%) in the IFN-alpha group and 53 (78%) in the BMT group. In the IFN-alpha group, a complete cytogenetic response was induced in 25 patients (15%), a partial cytogenetic response in 37 (23%), and a minor cytogenetic response in 41 (25%). At a median follow-up of 38 months, in the IFN-alpha group the predicted 5-year survival rate was 79%, and the predicted 5-year rate of remaining in chronic phase was 66%. In the BMT group the predicted 5-year survival rate was 72% for related-donor BMT and 67% for unrelated-donor BMT. Among low Sokal-risk patients, 5-year survival did not differ between IFN-alpha therapy and BMT, irrespective of age. In higher Sokal-risk patients, survival for related-donor BMT and unrelated-donor BMT tended to be better than that with IFN-alpha therapy in younger patients. On the other hand, in older patients, survival in the BMT group, especially for those receiving unrelated-donor BMT, appeared to be inferior to that in the IFN-alpha group. Unrelated-donor BMT can be recommended for high-risk younger patients. However, for older patients, it should be performed after careful consideration of prognostic factors such as age, Sokal score, and response to IFN-alpha.
Ohnishi
K
K
Department of Medicine III, Hamamatsu University School of Medicine, Handayama, Japan. kohnishi@hama-med.ac.jp
Ino
T
T
Kishimoto
Y
Y
Usui
N
N
Shimazaki
C
C
Ohtake
S
S
Taguchi
H
H
Kusumoto
S
S
Kuriyama
K
K
Hotta
T
T
Ohno
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use*; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate
D000970:Antineoplastic Agents; D016898:Interferon-alpha; D006918:Hydroxyurea