Multicenter prospective study of interferon-alpha versus bone marrow transplantation for newly diagnosed patients with chronic myelogenous leukemia: a preliminary analysis

Interferon-alpha (IFN-alpha) therapy was compared with bone marrow transpla ntation (BMT) in patients with chronic myelogenous leukemia (CML) in a mult icenter, prospective study. Of 254 evaluable patients, 175 received IFN-alp ha and 79 received allogeneic BMT, 50 of whom received transplants from hum an leukocyte antigen (HLA)-identical related donors and 29 from HLA-matched unrelated donors. Complete hematologic response was achieved by 148 patien ts (89%) in the IFN-alpha group and 53 (78%) in the BMT group. In the IFN-a lpha group, a complete cytogenetic response was induced in 25 patients (15% ), a partial cytogenetic response in 37 (23%), and a minor cytogenetic resp onse in 41 (25%). At a median follow-up of 38 months, in the IFN-alpha grou p the predicted 5-year survival rate was 79%, and the predicted 5-year rate of remaining in chronic phase was 66%. In the BMT group the predicted 5-ye ar survival rate was 72% for related-donor BMT and 67% for unrelated-donor BMT. Among low Sokal-risk patients, 5-year survival did not differ between IFN-alpha therapy and BMT, irrespective of age. In higher Sokal-risk patien ts, survival for related-donor BMT and unrelated-donor BMT tended to be bet ter than that with IFN-alpha, therapy in younger patients. On the other han d, in older patients, survival in the BMT group, especially for those recei ving unrelated-donor BMT, appeared to be inferior to that in the IFN-alpha group. Unrelated-donor BMT can be recommended for high-risk younger patient s. However, for older patients, it should be performed after careful consid eration of prognostic factors such as age, Sokal score, and response to IFN -alpha.