M. Bornhauser et al., Dose-reduced conditioning for allografting in 44 patients with chronic myeloid leukaemia: a retrospective analysis, BR J HAEM, 115(1), 2001, pp. 119-124
This retrospective study describes the outcome of patients with chronic mye
loid leukaemia after allografting using dose-reduced conditioning with flud
arabine and busulphan. Forty-four Philadelphia chromosome (Ph)-positive pat
ients were transplanted in nine German centres; 26 patients were in chronic
phase, 11 in accelerated phase and seven in blast crisis. Thirty-four pati
ents achieved complete remission, with 18 alive and disease-free at a media
n followup of 562 d (range 244-922 d). Grade II-IV acute graft-versus-host
disease (GVHD) incidence was 43%. Twenty patients died, 15 of causes unrela
ted to relapse. Risk factors predisposing to graft failure by univariate an
alysis were an unrelated donor (8/23 compared with a related donor 2/21, P
= 0.07) and interferon therapy within 90 d of transplant (4/6 versus 3/17,
P = 0.025). At the last follow-up, of 31 patients for whom molecular or cyt
ogenetic data were available, 16 (52%) were polymerase chain reaction-negat
ive, and seven (23%) were Ph-negative by fluorescent in situ hybridization.
These findings demonstrate that dose-reduced conditioning with fludarabine
and busulphan provides durable engraftment and a low rate of relapse. Howe
ver, in this population, many of whom were not eligible for high-dose condi
tioning due to age, reduced performance status, previous complications or e
xtensive pre-treatment, these data highlight the need for effective anti-in
fectious and GVHD prophylaxis. in addition, this study supports the discont
inuation of interferon therapy at least 90 d before transplant.