In 117 patients with chronic myelogenous leukaemia (CML) treatment with a combination of high-dose chemoradiotherapy plus transplantation of allogeneic bone-marrow from HLA-identical, mixed-lymphocyte-culture-identical siblings resulted in an actuarial probability of 3-year survival of 63±16% (95% confidence interval) for 39 patients transplanted in chronic phase; 36±14% for 56 transplanted in accelerated phase; and 12±15% for 22 transplanted during blast crisis. Irrespective of disease status at the time of transplantation, and in contrast to chemotherapy, a plateau-effect was observed in the survival curves starting 14 to 19 months after transplantation. The actuarial probability of recurrent or persistent leukaemia at 3 years was 7±9% for patients transplanted in chronic phase, 41+19% for accelerated phase, and 41±39% for blastic phase. All relapses occurred within 18 months of transplantation. This study demonstrates that long-term disease-free survival in CML can be achieved with bone-marrow transplantation. Best results were obtained in patients transplanted during chronic phase of the disease.
Bibliographical noteFunding Information:
Foundation, Burroughs Wellcome Fund, Charles E. Culpeper Foundation, Lederle Laboratories, Ambrose Monell Foundation, Samuel Roberts Noble Foundation, Sandoz Inc, Sandoz Ltd, Swiss Cancer League, and Upjohn Company. It was carried out under contract NOI-AI-32532 from the National Institute of Allergy and Infectious Diseases and the National Cancer Institute and contract BIO.C.520.US (H) from the Commission of the European Communities. We thank Ms D’Etta Waldoch and Ms Deborah Schaefer for help in data analysis and Ms Patricia Minks for help in preparation of the manuscript. Institutes contributing patient data for this report are: Academisch Ziekenhuis-Leiden, Leiden, The Netherlands; Academisch Ziekenhuis St Rafael, Leuven, Belgium; Case-Western Reserve University, Cleveland, USA; Children’s Hospital of Philadelphia, Philadelphia, USA; Cleveland Clinic, Cleveland, USA; Daini Red Cross Hospital, Nagoya, Japan; Emory University School of Medicine, Atlanta, USA; J. Hillis Miller Health Center, Gainesville, USA; Hopital Bellevue, Saint Etienne, France; Hopital Saint Louis, Paris, France; Huddinge University Hospital, Huddinge, Sweden; Kanazawa University School of Medicine, Kanazawa-shi, Japan; Kantonsspital, Basel, Switzerland; Kantonsspital, Zurich, Switzerland; Loyola University Medical Center, Chicago, USA; McMaster University, Hamilton, Canada; Medizinische Umversitatsklinik, Tubingen, Germany; Memorial Sloan-Kettering Cancer Center, New York, USA; Ontario Cancer Institute, Toronto, Canda; Ospedale di Pesaro, Pesaro, Italy; Ospedale San Martino, Genoa, Italy; Roswell Park Memorial Institute, Buffalo, USA; Royal Free Hospital, London, England; Royal Hobart Hospital, Hobart, Australia; Royal Marsden Hospital, London, England; Royal Postgraduate Medical School, London, England; St Vincent’s Hospital, Sydney, Australia; Universita-Chieti, Pescara, Italy; Universitat Ulm, UlmlDonau, West Germany; University of Alabama in Birmingham, Birmingham, USA; UCLA Center for Health Sciences, Los Angeles, USA; University of Cape Town Research Centre/Groote Schuur Hospital, Cape, South Africa; University Hospital, Leiden, The Netherlands; University of Minnesota, Minneapolis, USA; Victoria Infirmary, Glasgow, Scotland; and Westminster Medical School, London, England.