Intensive treatment and stem cell transplantation in chronic myelogenous leukemia : long-term follow-up

• In the present study we combined interferon (IFN) and hydroxyurea (HU) treatment, intensive chemotherapy and autologous stem cell transplantation (SCT) in newly diagnosed chronic myelogenous leukemia patients aged below 56 years, not eligible for allogeneic SCT. Patients who had an HLA-identical sibling donor and no contraindication went for an allogeneic SCT (related donor, RD). After diagnosis, patients not allotransplanted received HU and IFN to keep WBC and platelet counts low. After 6 months patients with Ph-positive cells still present in the bone marrow received 1–3 courses of intensive chemotherapy. Those who became Ph-negative after IFN + HU or after 1–3 chemotherapy courses underwent autologous SCT. Some patients with poor cytogenetic response were allotransplanted with an unrelated donor (URD). IFN + HU reduced the percentage of Ph-positive metaphases in 56% of patients, and 1 patient became Ph-negative. After one or two intensive cytotherapies 86 and 88% had a Ph reduction, and 34 and 40% became Ph-negative, respectively. In patients receiving a third intensive chemotherapy 92% achieved a Ph reduction and 8% became Ph-negative. The median survival after auto-SCT (n = 46) was 7.5 years. The chance of remaining Ph-negative for up to 10 years after autologous SCT was around 20%. The overall survival for allo-SCT RD (n = 91) and URD (n = 28) was almost the same, i.e. ≈60% at 10 years. The median survival for all 251 patients registered was 8 years (historical controls 3.5 years). The role of the treatment schedule presented in the imatinib era is discussed.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Hematologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Hematology (hsv//eng)

Nyckelord

Adolescent

Adult

Antineoplastic Agents/administration & dosage

Antineoplastic Combined Chemotherapy Protocols/*administration & dosage

Denmark

Female

Follow-Up Studies

Hematopoietic Stem Cell Transplantation

Humans

Hydroxyurea/administration & dosage

Interferons/administration & dosage

Leukapheresis

Leukemia; Myeloid; Philadelphia-Positive/mortality/*therapy

Male

Middle Aged

Multicenter Studies

Survival Analysis

Sweden

Transplantation; Autologous

Transplantation; Homologous

chronic myelogenous leukemia

chemotherapy

intensive

interferon

stem

cell transplantation

autologous and allogeneic

MEDICINE

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)