A prospective study of alpha-interferon and autologous bone marrow transplantation in chronic myeloid leukemia

Background and Objective. alpha-interferon (alpha IFN) can Induce cytogenet ic remissions In chronic myeloid leukemia (CML). Hemopoietic progenitors ca n be collected from the marrow in remission and utilized for autologous rep opulation after high dose chemotherapy. This study was designed with the pu rpose of evaluating the feasibility of a combined treatment policy of alpha IFN followed by autologous bone marrow transplantation (autoBMT). Design and Methods. A prospective study of alpha IFN and autoBMT was begun in 1989. Two hundred and seventy-two consecutive previously untreated nonbl astic Ph positive chronic myeloid leukemia (CML) patients, who were less th an 56 years old, were enrolled over a 3-year period (1989-1991) and were as signed to receive human recombinant alpha IFN 2a (Roferon-A) at a dose of 9 MIU daily for at least one year. If they achieved a cytogenetic response c onsisting in a percentage of Ph neg metaphases of more than 25%, they were eligible for marrow harvesting and subsequent autografting after high dose busulfan (16 mg/kg) and melphalan (60 mg/m(2)). Results. Seventy-six patients (28%) were eligible for a marrow harvest but the marrow was harvested in only 37 cases (14%), and only twenty-three pati ents (8%) were actually autografted. One patient died of infection nine day s after autoBMT. The other patients recovered and did not suffer any late a dverse events. Five patients progressed to blastic phase, six are alive in complete hematologic remission and eleven are alive in complete hematologic and cytogenetic remission. alpha IFN treatment was reinstituted after auto BMT in 18 of 22 cases, but four patients who are in continuous complete cyt ogenetic remission were not given alpha IFN anymore. The progression-free s urvival of the autografted patients is 65% 8 years after registration. Interpretation and Conclusions. This study shows that bone marrow hemopoiet ic progenitors (Ph neg and Ph pas) can be collected from patients who respo nd to alpha IFN and can be used to rescue hemopoietic activity after high d ose chemotherapy. Though some complete and durable cytogenetic remissions w ere obtained, the treatment could be applied only to a small group of good risk patients, highlighting that selection is very important and results ca nnot be extrapolated to the average patient. (C)1999, Ferrata Storti Founda tion.