SURVIVAL IN FIRST OR 2ND REMISSION AFTER LYMPHOCYTE-DEPLETED TRANSPLANTATION FOR PHILADELPHIA-CHROMOSOME-POSITIVE CML IN FIRST CHRONIC PHASE

We studied the outcome of BMT in 38 consecutive CML patients in CP1 wh o received transplants depleted of lymphocytes using counterflow centr ifugation. In all patients the conditioning regimen was intensified by the addition of anthracyclines. Donors were HLA, MLC-identical siblin gs. Six patients (16%) died within 6 months. All 37 patients with a fo llow-up of more than 0.5 months engrafted and only one (3%) suffered f rom acute GVHD greater than or equal to grade 3. Chronic GVHD was eval uable in 33 patients and was extensive in six (18%). The projected 5-y ear probabilities of hematologic, cytogenetic and molecular relapse we re 30% (95% confidence interval (CI), 10-49%), 35% (95% CI, 14-56%), a nd 34% (95% CI, 13-55%), respectively. The projected 5-year probabilit y of survival was 68% (95% CI, 50-86%). Projected at 5 years, probabli ties of leukemia-free survival (LFS) in hematologic, cytogenetic and m olecular remission were 55% (95% CI, 37-73%), 51% (95% CI, 32-69%), an d 51% (95% CI, 32-70%), respectively. All patients with relapse but on e who relapsed in blastic phase were treated with retransplantation (n = 1) or with the infusion of lymphocytes (n = 6). Six patients regain ed second hematologic remission and five entered second cytogenetic an d molecular remission. Including these patients, the probability of su rvival in first or second hematologic remission at the end of follow-u p was 68% (95% CI, 50-86%). The probabilities of survival in first or second cytogenetic and molecular remission at the end of follow-up wer e both 61% (95% CI, 42-80%). We advocate revaluation of T cell depleti on of donor marrow for patients with CML-CP1, especially for those at high risk of developing GVHD.