Targeted agents for chronic myelogenous leukemia: will that be the end of allogeneic bone marrow transplantation for that disease?
Although the drug imatinib has been accepted as the treatment of choice for chronic myelogenous leukemia (CML) in chronic phase (CP) throughout the Western world, allogeneic stem cell transplantation (allo-SCT) continues to remain a widely practiced first-line treatment in countries with limited health care budgets. The rationale is not scientific, but largely economically based. We analyzed a cohort of 46 CML patients who participated in a graft-versus-host disease (GVHD) prophylaxis clinical trial and underwent related HLA-matched allogeneic peripheral blood stem cell transplantation. The median time of follow-up in surviving patients was 43 months (range: 4-89 months). Risk stratification of the population was done by European Blood and Marrow Transplant (EBMT) criteria. The estimated probabilities of overall survival (OS) and leukemia-free survival (LFS) at 3 years in low EBMT risk score (0-2) patients were both 91%, respectively. We conclude that in countries with restricted access to imatinib, allo-SCT should be considered early on as front-line therapy. Continued research support for bone marrow transplantation will be needed to make a global impact on this disease.
Liang
Yuzhen
Y
The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
Lai
Yongrong
Y
Schwarzenberger
Paul
P
Li
Qiaochuan
Q
Ma
Jie
J
Luo
Jun
J
Liu
Rongrong
R
Shi
Lingling
L
Zhou
Jicheng
J
Peng
Zhigang
Z
Yang
Jie
J
Deng
Donghong
D
Zhou
Yizhen
Y
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D001549:Benzamides; D016026:Bone Marrow Transplantation / Q000191:economics* / Q000379:methods; D002648:Child; D018450:Disease Progression; D018572:Disease-Free Survival; D004358:Drug Therapy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000191:economics / Q000379:methods; D010879:Piperazines / Q000191:economics / Q000627:therapeutic use; D011743:Pyrimidines / Q000191:economics / Q000627:therapeutic use; D012008:Recurrence; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate