Second chronic phase before transplantation is crucial for improving survival of blastic phase chronic myeloid leukaemia

Because successful outcome after transplantation seems to depend in acute m yeloid leukaemia (AML) and in chronic phase chronic myeloid leukaemia (CML) on disease status at the time of transplantation, we investigated whether FLAN (fludarabine, cytosine arabinoside, mitoxantrone) induction before all ogeneic stem cell transplantation (allo-SCT) may be useful in blastic phase (BP)-CML. Twenty patients with BP-CML were studied: 10 patients received F LAN induction chemotherapy before proceeding to early allo-SCT, whereas 10 patients were submitted to bone marrow transplantation (BMT) without remiss ion induction. Eight out of 10 (80%) patients achieved second chronic phase after one course of therapy with FLAN and seven patients (six in second ch ronic phase and one with partial response) were then submitted to allo-SCT. Of the six patients transplanted in the second chronic phase, all achieved molecular remission, four are still in second chronic phase, with interval s ranging from 10 to 54 months, whereas one patient died from infection hav ing relapsed 14 months after SCT and one died of transplant-related complic ations in the second chronic phase. Mean durations of second chronic phase and survival after allo-SCT were both significantly longer than in the grou p of 10 BP-CML patients submitted to allo-SCT without FLAN remission induct ion treatment [22.4 (range 1-61) vs. 3.5 months (range 1-10) with FLAN and 22.7 (range 2-61) vs. 6.4 (range 1-16) months without FLAN]. We conclude th at FLAN induction therapy followed by early allo-SCT appears to be effectiv e in the treatment of BP-CML and could provide a curative possibility for B P-CML patients.