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Outcome of Chinese patients with chronic myeloid leukaemia (CML) underwent allogeneic bone‐marrow transplantation (BMT)
Author(s) -
Lee C.K.,
Lie A.K.W.,
Liang R.,
Au W.Y.,
Chen F.E.,
Chim C.S.,
Kwong Y.L.
Publication year - 1999
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/(sici)1096-8652(199906)61:2<85::aid-ajh1>3.0.co;2-z
Subject(s) - medicine , incidence (geometry) , gastroenterology , bone marrow , methotrexate , cohort , transplantation , surgery , optics , physics
Clinical studies have shown that patients with chronic myeloid leukaemia (CML) treated with allogeneic bone‐marrow transplantation (BMT) experience not only prolonged disease‐free survival but also complete cure in some. Therefore, we followed a cohort of 81 Chinese patients who received allogeneic BMT. Patients and Methods The donors were either relatives (65 siblings, 1 parent) or unrelated volunteers (15). BMT was performed at a median interval of 11.6 months from diagnosis of CML, and the stages of disease before BMT were: first chronic phase (60 patients), accelerated or second chronic phase in (10 patients), and blastic crisis (11 patients). Three conditioning regimens were employed: Bu‐Cy, Cy‐TBI, or Bu‐Cy‐TBI. Standard cyclosporin and short methotrexate protocol were used for acute graft‐versus‐host disease (GvHD) prophylaxis. Results There were five graft failures with three after related BMT. Patients after related or unrelated BMT had a comparable rate of neutrophil recovery (median = 22 days), but significant delay in platelet recovery occurred after unrelated BMT (median = 34 vs. 20 days, P < 0.05). The latter also had higher incidence of acute GvHD (73% vs. 41%, P < 0.05), although the incidence of chronic GvHD was not different between groups. At a median follow‐up of 43.5 months, patients after related BMT had a significantly better rate of disease‐free survival (68% vs. 37.3%, P < 0.05) and overall survival (81% vs. 38.9%, P < 0.05) at 4 years. Subgroup analysis of patients after related BMT showed the outcome was better when they were transplanted at first chronic phase. Multivariate analysis showed that advanced disease (RR = 2.01, 95% CI = 1.48–2.73) significantly worsened the outcome of BMT, whereas the presence of chronic GvHD had a protective effect against relapse and survival (RR = 0.09, 95% CI = 0.02–0.38). Conclusion Allogeneic BMT is a curative form of treatment for patients with CML. Treatment outcome is best for those who undergo transplants from HLA‐matched siblings during the first chronic phase. Am. J. Hematol. 61:85–89, 1999. © 1999 Wiley‐Liss, Inc.