title: Intensive treatment and stem cell transplantation in chronic myelogenous leukemia: long-term follow-up.
abstract: 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.
authors.affiliation: Department of Medicine and Hematology, University Hospital, Uppsala, Sweden. bengt.simonsson@medsci.uu.se
authors.forename: Bengt
authors.initials: B
authors.lastname: Simonsson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Oberg
authors.forename: Mats
authors.initials: M
authors.lastname: Bjoreman
authors.forename: Magnus
authors.initials: M
authors.lastname: Bjorkholm
authors.forename: Jan
authors.initials: J
authors.lastname: Carneskog
authors.forename: Karin
authors.initials: K
authors.lastname: Karlsson
authors.forename: Gosta
authors.initials: G
authors.lastname: Gahrton
authors.forename: Gunnar
authors.initials: G
authors.lastname: Grimfors
authors.forename: Robert
authors.initials: R
authors.lastname: Hast
authors.forename: Hans
authors.initials: H
authors.lastname: Karle
authors.forename: Olle
authors.initials: O
authors.lastname: Linder
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Johan L
authors.initials: JL
authors.lastname: Nielsen
authors.forename: Jonas
authors.initials: J
authors.lastname: Nilsson
authors.forename: Eva
authors.initials: E
authors.lastname: Lofvenberg
authors.forename: Claes
authors.initials: C
authors.lastname: Malm
authors.forename: Karin
authors.initials: K
authors.lastname: Olsson
authors.forename: Ulla
authors.initials: U
authors.lastname: Olsson-Stromberg
authors.forename: Christer
authors.initials: C
authors.lastname: Paul
authors.forename: Leif
authors.initials: L
authors.lastname: Stenke
authors.forename: Jesper
authors.initials: J
authors.lastname: Stentoft
authors.forename: Ingemar
authors.initials: I
authors.lastname: Turesson
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Udén
authors.forename: Anders
authors.initials: A
authors.lastname: Wahlin
authors.forename: Lars
authors.initials: L
authors.lastname: Vilén
authors.forename: Ole
authors.initials: O
authors.lastname: Weis-Bjerrum
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D007372:Interferons; D006918:Hydroxyurea