Intensive treatment and stem cell transplantation in chronic myelogenous leukemia: long-term follow-up.
In the present study we combined interferon (IFN) and hydroxyurea (HU) treatment, intensive chemotherapy and autologous stem cell transplantation (SCT) in newly diagnosed chronic myelogenous leukemia patients aged below 56 years, not eligible for allogeneic SCT. Patients who had an HLA-identical sibling donor and no contraindication went for an allogeneic SCT (related donor, RD). After diagnosis, patients not allotransplanted received HU and IFN to keep WBC and platelet counts low. After 6 months patients with Ph-positive cells still present in the bone marrow received 1-3 courses of intensive chemotherapy. Those who became Ph-negative after IFN + HU or after 1-3 chemotherapy courses underwent autologous SCT. Some patients with poor cytogenetic response were allotransplanted with an unrelated donor (URD). IFN + HU reduced the percentage of Ph-positive metaphases in 56% of patients, and 1 patient became Ph-negative. After one or two intensive cytotherapies 86 and 88% had a Ph reduction, and 34 and 40% became Ph-negative, respectively. In patients receiving a third intensive chemotherapy 92% achieved a Ph reduction and 8% became Ph-negative. The median survival after auto-SCT (n = 46) was 7.5 years. The chance of remaining Ph-negative for up to 10 years after autologous SCT was around 20%. The overall survival for allo-SCT RD (n = 91) and URD (n = 28) was almost the same, i.e. approximately 60% at 10 years. The median survival for all 251 patients registered was 8 years (historical controls 3.5 years). The role of the treatment schedule presented in the imatinib era is discussed.
Simonsson
Bengt
B
Department of Medicine and Hematology, University Hospital, Uppsala, Sweden. bengt.simonsson@medsci.uu.se
Oberg
Gunnar
G
Bjoreman
Mats
M
Bjorkholm
Magnus
M
Carneskog
Jan
J
Karlsson
Karin
K
Gahrton
Gosta
G
Grimfors
Gunnar
G
Hast
Robert
R
Karle
Hans
H
Linder
Olle
O
Ljungman
Per
P
Nielsen
Johan L
JL
Nilsson
Jonas
J
Lofvenberg
Eva
E
Malm
Claes
C
Olsson
Karin
K
Olsson-Stromberg
Ulla
U
Paul
Christer
C
Stenke
Leif
L
Stentoft
Jesper
J
Turesson
Ingemar
I
Udén
Ann-Marie
AM
Wahlin
Anders
A
Vilén
Lars
L
Weis-Bjerrum
Ole
O
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D007372:Interferons / Q000008:administration & dosage; D007937:Leukapheresis; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016019:Survival Analysis; D013548:Sweden; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000970:Antineoplastic Agents; D007372:Interferons; D006918:Hydroxyurea