Outcomes of reduced-intensity transplantation for chronic myeloid leukemia: an analysis of prognostic factors from the Chronic Leukemia Working Party of the EBMT.
This study reports outcomes of allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning (RIC) in 186 patients with chronic myeloid leukemia (CML) from the European Group for Blood and Marrow Transplantation (EBMT). The median age was 50 years, and 64% were in first chronic phase (CP1), CP2 13%, accelerated phase 17%, and blast crises 6%. The median EBMT transplant score was 3. The day 100 transplantation-related mortality (TRM) was 6.1% (confidence interval [CI], 3.4%-11%) but rose to 23.3% (CI, 14%-27%) at 2 years. Fludarabine, busulfan, and antithymocyte globulin (Fd/Bu/ATG) was associated with the lowest TRM of 11.6% (CI, 4.7%-11%) at 1 year. Acute graft-versus-host disease (GvHD) grade II to IV occurred in 32% and chronic GvHD in 43% (extensive in 24%). ATG was associated with a lower incidence of chronic GvHD (cGvHD). The overall survival (OS) and progression-free survival (PFS) at 3 years were 58% (CI, 50%-66%) and 37% (CI, 30%-45%), respectively. Adverse OS was associated with advanced disease (relative risk [RR], 3.4). PFS was inferior in advanced disease (RR, 2.7) and a trend to improved outcomes with Fd/Bu/ATG (RR, 0.58). RIC allografts are feasible in CML in first or second CP. Since no other RIC regimen demonstrated superiority, Fd/Bu/ATG should be considered as baseline in future prospective trials.
Clinical Haematology, Box 234, Addenbrookes Hospital, Cambridge, CB2 2QQ United Kingdom. charles.crawley@addenbrookes.nhs.uk
Charles
C
Crawley
Richard
R
Szydlo
Marc
M
Lalancette
Andrea
A
Bacigalupo
Andrzej
A
Lange
Mats
M
Brune
Gunnar
G
Juliusson
Arnon
A
Nagler
Alois
A
Gratwohl
Jakob
J
Passweg
Mieczyslaw
M
Komarnicki
Antonin
A
Vitek
Jiri
J
Mayer
Axel
A
Zander
Jorge
J
Sierra
Alessandro
A
Rambaldi
Olle
O
Ringden
Dietger
D
Niederwieser
Jane F
JF
Apperley
D000293:Adolescent; D000328:Adult; D000368:Aged; D001549:Benzamides; D016026:Bone Marrow Transplantation; D018450:Disease Progression; D005060:Europe; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use; D011379:Prognosis; D011743:Pyrimidines / Q000627:therapeutic use; D012307:Risk Factors; D012958:Societies, Scientific; D015996:Survival Rate; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate