title: Late mortality and relapse following BuCy2 and HLA-identical sibling marrow transplantation for chronic myelogenous leukemia.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only known curative therapy for chronic myelogenous leukemia (CML). Failure, because of relapse or nonrelapse mortality (NRM), generally occurs within 3 years of transplantation, but large studies with long-term follow-up are limited. We present mature results in 335 patients with CML who underwent allogeneic bone marrow transplantation (BMT) from HLA-identical siblings following busulfan and cyclophosphamide (BU/Cy2). Two hundred twenty-nine were in chronic phase (CP) and 106 in accelerated or blastic phase at transplantation. Median follow-up exceeded 14 years. The estimated probability of 18-year leukemia-free survival (LFS) for CP patients was 55.6% and for those beyond CP, 10.5%. Of 182 patients who survived leukemia-free at 3 years, the estimated probability of LFS at 18 years was 61.9%. Late relapse (P = .039) and late NRM (P = .008) occurred at higher rates in patients beyond CP at transplantation. There was no plateau in LFS.
authors.affiliation: Department of Hematologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. copelae@ccf.org
authors.forename: Edward A
authors.initials: EA
authors.lastname: Copelan
authors.forename: Pamela Ann
authors.initials: PA
authors.lastname: Crilley
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Szer
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dodds
authors.forename: Dustin
authors.initials: D
authors.lastname: Stevenson
authors.forename: Gary
authors.initials: G
authors.lastname: Phillips
authors.forename: Patrick
authors.initials: P
authors.lastname: Elder
authors.forename: Ian
authors.initials: I
authors.lastname: Nivison-Smith
authors.forename: Belinda R
authors.initials: BR
authors.lastname: Avalos
authors.forename: Sam
authors.initials: S
authors.lastname: Penza
authors.forename: David
authors.initials: D
authors.lastname: Topolsky
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D002066:Busulfan / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D035781:Siblings; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D003520:Cyclophosphamide; D002066:Busulfan