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Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia

Authors :
O. Maywald
T. Lahaye
Hans-Jochem Kolb
Ute Berger
Alois Gratwohl
Helmut Löffler
Andreas Tobler
Klaus Lechner
Hartmut Kirchner
Hermann Heimpel
Wolfgang Queisser
Joerg Hasford
Andreas Reiter
Dieter K. Hossfeld
Mariele Goebeler
Wolf-Dietrich Hirschmann
Max Solenthaler
Hans Pralle
Rüdiger Hehlmann
Andreas Hochhaus
Markus Pfirrmann
Christoph Huber
Christoph Nerl
Christiane Falge
Stephan Kremers
Martin Griesshammer
Thomas Fischer
Hartmut Eimermacher
Michael Pfreundschuh
Barbara Wassmann
Source :
Blood. 109:4686-4692
Publication Year :
2007
Publisher :
American Society of Hematology, 2007.

Abstract

Early allogeneic hematopoietic stem cell transplantation (HSCT) has been proposed as primary treatment modality for patients with chronic myeloid leukemia (CML). This concept has been challenged by transplantation mortality and improved drug therapy. In a randomized study, primary HSCT and best available drug treatment (IFN based) were compared in newly diagnosed chronic phase CML patients. Assignment to treatment strategy was by genetic randomization according to availability of a matched related donor. Evaluation followed the intention-to-treat principle. Six hundred and twenty one patients with chronic phase CML were stratified for eligibility for HSCT. Three hundred and fifty four patients (62% male; median age, 40 years; range, 11-59 years) were eligible and randomized. One hundred and thirty five patients (38%) had a matched related donor, of whom 123 (91%) received a transplant within a median of 10 months (range, 2-106 months) from diagnosis. Two hundred and nineteen patients (62%) had no related donor and received best available drug treatment. With an observation time up to 11.2 years (median, 8.9 years), survival was superior for patients with drug treatment (P = .049), superiority being most pronounced in low-risk patients (P = .032). The general recommendation of HSCT as first-line treatment option in chronic phase CML can no longer be maintained. It should be replaced by a trial with modern drug treatment first.

Details

ISSN :
15280020 and 00064971
Volume :
109
Database :
OpenAIRE
Journal :
Blood
Accession number :
edsair.doi.dedup.....090f33e9c6a4983dc3d5201116f2eae2
Full Text :
https://doi.org/10.1182/blood-2006-11-055186