title: Factors affecting duration of survival after onset of blastic transformation of chronic myeloid leukemia.
abstract: We analyzed factors having an impact on response to treatment and survival in 78 consecutive patients with chronic myeloid leukemia (CML) in blastic transformation (BT) referred to the Hammersmith Hospital from January 1995 to December 2000. BT was defined as the presence of at least 30% blasts in blood or marrow or extramedullary blastic deposits. Immunophenotyping of blasts showed 57 myeloid, 19 lymphoid, and 2 biphenotypic. The median age of the patients was 39.1 years (range, 11.3-73.4 years), with 55 males and 23 females. The median survival for all patients after onset of BT was 8.2 months (95% CI, 6.4-10). Patients in lymphoid BT survived longer than those in myeloid BT (median, 11.2 months versus 6.9 months, P =.052). Initial treatment varied; 41 patients received cytotoxic drugs, 8 underwent allogeneic or autologous transplantation procedures, 21 received STI571 (imatinib mesylate, Gleevec), 1 received radiotherapy, and 7 received no therapy. Of the 25 (32%) patients who achieved a "second chronic phase" with first therapy, 6 of 21 (29%) were treated with STI571 and 19 of 50 (38%) were treated with chemotherapy, transplantation, or radiotherapy. Patients who achieved a second chronic phase survived longer than those who did not (median time from onset of BT 12.0 months versus 6.3 months, P =.0004). In multivariate analysis the finding of more than 50% blast cells in the blood and the presence of cytogenetic progression were independent adverse prognostic variables for survival. We conclude that survival after onset of BT has improved in recent years but is still unsatisfactory. We speculate that the combined use of STI571 with cytotoxic drugs may offer additional benefit.
authors.affiliation: Department of Haematology, Hammersmith Hospital and Faculty of Medicine, Imperial College at Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Wadhwa
authors.forename: Richard M
authors.initials: RM
authors.lastname: Szydlo
authors.forename: Jane F
authors.initials: JF
authors.lastname: Apperley
authors.forename: Andrew
authors.initials: A
authors.lastname: Chase
authors.forename: Marco
authors.initials: M
authors.lastname: Bua
authors.forename: David
authors.initials: D
authors.lastname: Marin
authors.forename: Eduardo
authors.initials: E
authors.lastname: Olavarria
authors.forename: Edward
authors.initials: E
authors.lastname: Kanfer
authors.forename: John M
authors.initials: JM
authors.lastname: Goldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001752:Blast Crisis / Q000401:mortality*; D002648:Child; D018572:Disease-Free Survival; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000097:blood / Q000401:mortality / Q000473:pathology*; D007958:Leukocyte Count; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents