Skip to main content

Advertisement

Log in

Long-term follow-up of allogeneic HSCT for CML reveals significant improvement in the outcome over the last decade

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Allogeneic hematopoetic stem cell transplantation (HSCT) is still the only curative therapeutic option for chronic myelogenous leukemia (CML). To examine the development of allogeneic HSCT at our center over the past two decades (decade 1: 1984–1994; decade 2: 1995–2005), all CML patients transplanted in first chronic phase (n = 234) were analyzed with respect to patient characteristics, overall survival, transplant-related mortality (TRM), and relapse incidence. The median follow up time was 54 months (range 1–218). The incidence of acute graft vs host disease (GvHD) °II–IV and extensive chronic GvHD were not different between the two decades (p = 0.894 and p = 0.422, respectively). There was also no difference in the relapse incidence (23 vs 26%, p = 0.869). One-year TRM and overall survival were improved in the later decade (33 vs 18%, p = 0.011 and 62 vs 73% at 5 years, p = 0.063, respectively). The major reason for improved outcome in decade 2 was the improved management of acute GvHD and infections in the early phase after transplantation (p = 0.026). In conclusion, the past decade has seen significant improvement in the performance of allogeneic HSCT for CML.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Clift RA, Buckner CD, Thomas ED et al (1994) Marrow transplantation for chronic myeloid leukaemia: a randomized study comparing cyclophosphamide and total body irradiation with busulfan and cyclophosphamide. Blood 84:2036–2043

    PubMed  CAS  Google Scholar 

  2. Druker BJ, Sawyers CL, Kantarjian H, Resta DJ, Reese SF, Ford JM Capdeville R, Talpaz Ml (2001) Activity of a specific inhibitor of the BCR-ABL tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. N Engl J Med 344:1038–1042

    Article  PubMed  CAS  Google Scholar 

  3. Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM, Lydon NB, Kantarjian H, Capdeville R, Ohno-Jones S, Sawyers CL (2001) Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia. N Engl J Med 344:1031–1037

    Article  PubMed  CAS  Google Scholar 

  4. Gale RP, Hehlmann R, Zhang MJ, Hasford J, Goldman JM, Heimpel H, Hochhaus A, Klein JP, Kolb HJ, McGlave PB, Passweg JR, Rowlings PA, Sobocinski KA, Horowitz MM (1998) Survival with bone marrow transplantation versus hydroxyurea or interferon for chronic myelogenous leukemia. The German CML Study Group. Blood 91:1810–1919

    PubMed  CAS  Google Scholar 

  5. Gratwohl A, Hermans J, Goldman JM et al (1998) Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Lancet 352:1087–1092

    Article  PubMed  CAS  Google Scholar 

  6. Hill GR, Crawford JM, Cooke KR et al (1997) Total body irradiation and acute graft-versus-host disease: the role of gastrointestinal damage and inflammatory cytokines. Blood 90:3204–3213

    PubMed  CAS  Google Scholar 

  7. Kolb HJ, Mittermuller J, Clemm C et al (1990) Donor leukocyte transfusions for treatment of recurrent chronic myelogenous leukaemia in marrow transplant patients. Blood 76:2462–2465

    PubMed  CAS  Google Scholar 

  8. Kolb HJ, Schattenberg A, Goldman JM et al (1995) Graft-versus-leukaemia effect of donor lymphocyte transfusions in marrow grafted patients. European Group for Blood and Marrow Transplantation Working Party Chronic Leukaemia. Blood 86:2041–2050

    PubMed  CAS  Google Scholar 

  9. McGlave PB, Shu XO, Wen W et al (2000) Unrelated donor marrow transplantation for chronic myelogenous leukaemia: 9 years’ experience of the National Marrow Donor Program. Blood 95:2219–2225

    PubMed  CAS  Google Scholar 

  10. O’Brien SG, Guilhot F, Larson RA, Gathmann I, Baccarani M, Cervantes F, Cornelissen JJ, Fischer T, Hochhaus A, Hughes T, Lechner K, Nielsen JL, Rousselot P, Reiffers J, Saglio G, Shepherd J, Simonsson B, Gratwohl A, Goldman JM, Kantarjian H, Taylor K, Verhoef G, Bolton AE, Capdeville R, Druker BJ (2003) Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 348:994–1004

    Article  PubMed  CAS  Google Scholar 

  11. Or R, Shapira MY, Resnick I, Amar A, Ackerstein A, Samuel S, Aker M, Naparstek E, Nagler A, Slavin S (2003) Nonmyeloablative allogeneic stem cell transplantation for the treatment of chronic myeloid leukemia in first chronic phase. Blood 101(2):441–445

    Article  PubMed  CAS  Google Scholar 

  12. Przepiorka D, Smith TL, Folloder J et al (1999) Risk factors for acute graft-versus-host disease after allogeneic blood stem cell transplantation. Blood 94:1465–1470

    PubMed  CAS  Google Scholar 

  13. Santos GW, Tutschka PJ, Brookmeyer R et al (1983) Marrow transplantation for acute nonlymphocytic leukaemia after treatment with busulfan and cyclophosphamide. N Engl J Med 309:1347–1353

    Article  PubMed  CAS  Google Scholar 

  14. Sawyers CL, Hochhaus A, Feldman E, Goldman JM, Miller CB, Ottmann OG, Schiffer CA, Talpaz M, Guilhot F, Deininger MW, Fischer T, O’Brien SG, Stone RM, Gambacorti-Passerini CB, Russell NH, Reiffers JJ, Shea TC, Chapuis B, Coutre S, Tura S, Morra E, Larson RA, Saven A, Peschel C, Gratwohl A, Mandelli F, Ben-Am M, Gathmann I, Capdeville R, Paquette RL, Druker BJ (2002) Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis: results of a phase II study. Blood 99:3530–3539

    Article  PubMed  CAS  Google Scholar 

  15. Schleuning M, Gunther W, Ledderose G, Kolb HJ (2003) Dose-dependent effects of in vivo antithymocyte globulin during conditioning for allogeneic bone marrow transplantation from unrelated donors in patients with chronic phase CML. Bone Marrow Transplant 32:243–250

    Article  PubMed  CAS  Google Scholar 

  16. Talpaz M, Silver RT, Druker BJ, Goldman JM, Gambacorti-Passerini C, Guilhot F, Schiffer CA, Fischer T, Deininger MW, Lennard AL, Hochhaus A, Ottmann OG, Gratwohl A, Baccarani M, Stone R, Tura S, Mahon FX, Fernandes-Reese S, Gathmann I, Capdeville R, Kantarjian HM, Sawyers CL (2002) Imatinib induces durable hematologic and cytogenetic responses in patients with accelerated phase chronic myeloid leukemia: results of a phase 2 study. Blood 99:1928–1937

    Article  PubMed  CAS  Google Scholar 

  17. Thomas ED (1994) Stem cell transplantation: past, present and future. Stem Cells 12:539–544

    Article  PubMed  Google Scholar 

  18. Weisser M, Schleuning M, Ledderose G, Rolf B, Schnittger S, Schoch C, Schwerdtfeger R, Kolb HJ (2004) Reduced-intensity conditioning using TBI (8 Gy), fludarabine, cyclophosphamide and ATG in elderly CML patients provides excellent results especially when performed in the early course of the disease. Bone Marrow Transplant 34:1083–1088

    Article  PubMed  CAS  Google Scholar 

  19. Zander AR, Kroger N, Schleuning M, Finke J, Zabelina T, Beelen D, Schwerdtfeger R, Baurmann H, Bornhauser M, Ehninger G, Fauser AA, Kiehl M, Trenschel R, Ottinger HD, Bertz H, Berger J, Kolb HJ, Schaefer UW (2003) ATG as part of the conditioning regimen reduces transplant-related mortality (TRM) and improves overall survival after unrelated stem cell transplantation in patients with chronic myelogenous leukemia (CML). Bone Marrow Transplant 32(4):355–361

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Martin Weisser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weisser, M., Ledderose, G. & Jochem Kolb, H. Long-term follow-up of allogeneic HSCT for CML reveals significant improvement in the outcome over the last decade. Ann Hematol 86, 127–132 (2007). https://doi.org/10.1007/s00277-006-0196-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-006-0196-z

Keywords

Navigation