BONE-MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA - LONG-TERM RESULTS

The data on 1480 bone marrow transplants for chronic myeloid leukemia (CML), performed between 1979 and 1990 were reported to the registry o f the European Group for Bone Marrow Transplantation (EBMT). Of these, 1082 patients were transplanted in first chronic phase, 88 in subsequ ent chronic phase, 251 in accelerated phase and 59 during blast crisis . For these four disease stages leukemia-free survival (LFS) at 5 year s is 39%, 22%, 22% and 0%, respectively. A more detailed analysis was performed for 947 patients receiving a first transplant in first chron ic phase of their disease from an HLA-identical sibling donor. Surviva l at 8 years is 47%. At 5 years, relapse incidence (RI) is 33% and the transplant-related mortality rate (TRM) is 42%. The major prognostic factors are patient age (LFS, TRM), T cell depletion (LFS, RI), time f rom diagnosis to transplant (LFS, TRM), white blood cell count (RI) an d donor-recipient sex combination (LFS, TRM). This first report on lon g-term results of a large cohort of transplanted CML patients confirms and extends previous findings. Stage of disease at time of transplant is the most important prognostic factor. Fifty per cent of all patien ts transplanted for CML in chronic phase can be expected to be alive a t 8 years post-transplant, 40% alive and free of the disease. This num ber increases to > 60% for patients given cyclosporin and methotrexate without T cell depletion as GVHD prophylaxis. However, there is no pl ateau phase and late relapses and late transplant-related deaths occur in alt subcategories. High risk patients can be identified, such as o lder male patients with a female donor.