Monitoring Treatment and Survival in Chronic Myeloid Leukemia

Abstract

PURPOSE: To monitor treatment results and survival in chronic myeloid leukemia after allogeneic bone marrow transplantation (alloBMT) and the introduction of interferon alpha (IFNα). PATIENTS AND METHODS: Disease course was monitored in 840 patients younger than 56 years who were registered onto prospective studies between 1984 and 1991 and were assigned to conventional chemotherapy (CHT) or IFNα therapy. One hundred twenty of these patients received allogeneic bone marrow in the chronic phase from an HLA-identical sibling without T-cell depletion (standard alloBMT). RESULTS: Patient distribution by risk and by presenting features was the same in the transplantation and nontransplantation cohorts, but age was different (median, 32 v 42 years). Results were analyzed by age and by Sokal's relative risk. Among low-risk patients, 10-year survival rates with standard alloBMT versus IFNα therapy versus CHT were 57% v 49% (P = .76) v 25% (P = .001), respectively, and among patients at higher risk, rates were 54% v 17% (P = .01) v 12% (P = .001). Among patients ≤ 32 years old, the 10-year survival rates were 65% v 35% (P = .05) v 24% (P = .001), respectively, but for patients older than 32 years, 10-year survival rates were 46% for standard alloBMT versus 31% for IFNα therapy (P = .62) versus 16% for conventional CHT (P = .05). The data did not change when the calculations were based on the transplantations that were performed within 1 year of diagnosis. CONCLUSION: Any policy of standard alloBMT was associated with significantly longer survival compared with conventional CHT, irrespective of age and risk. When the comparison was made with IFNα therapy, a policy of standard alloBMT, including early transplantation, was found to increase survival only in those patients who were younger or at intermediate or high risk.