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Survival With Bone Marrow Transplantation Versus Hydroxyurea or
Interferon for Chronic Myelogenous Leukemia
Robert Peter Gale,
Rüdiger Hehlmann,
Mei-Jie Zhang,
Joerg Hasford,
John M. Goldman,
Hermann Heimpel,
Andreas Hochhaus,
John P. Klein,
Hans-Jochem Kolb,
Philip B. McGlave,
Jakob R. Passweg,
Philip A. Rowlings,
Kathleen A. Sobocinski,
Mary M. Horowitz, and
the German CML Study Group
From the International Bone Marrow Transplant Registry, Health
Policy Institute, Medical College of Wisconsin, Milwaukee, WI; the
Division of Bone Marrow and Stem Cell Transplantation, Salick Health
Care, Inc, Los Angeles, CA; III. Medizinische Klinik, Klinikum
Mannheim, Universität Heidelberg, Mannheim, Germany; Institut
für Medizinische Informationsverarbeitung, Biometrie u.
Epidemiologie, München, Germany; the Royal Postgraduate Medical
School, Hammersmith Hospital, London, UK; University of Ulm, Ulm,
Germany; Universität München, München, Germany; and
the University of Minnesota, Minneapolis.
Hydroxyurea, interferon, and HLA-identical sibling bone
marrow transplantation are common therapies for chronic myelogenous leukemia (CML) in chronic phase. Which is best is controversial. The
purpose of this study was to compare survival of patients with CML
receiving HLA-identical sibling transplants versus hydroxyurea or
interferon. The transplant cohort included 548 recipients of HLA-identical sibling transplants, reported to the International Bone
Marrow Transplant Registry. The nontransplant cohort included 196 patients receiving hydroxyurea (n = 121) or interferon (n = 75) on
a randomized trial of the German CML Study Group. Survivals were
compared using proportional hazards regression with fixed and
time-dependent variables to adjust for patient differences and changing
risks over time. For the first 18 months after diagnosis, mortality was
higher in the transplant than the nontransplant cohort (relative risk
[RR], 5.85; P < .0001). From 18 to 56 months, mortality was
similar (RR, 0.80; P = .38). After 56 months, mortality was
lower in the transplant cohort (RR, 0.16; P < .0001).
Seven-year survival probabilities (95% confidence interval) were 58%
(50% to 66%) with transplant and 32% (22% to 41%) with hydroxyurea or interferon. There was a significant survival advantage for hydroxyurea or interferon in the first 4 years after diagnosis and for
transplants starting 5.5 years after diagnosis. For transplants done
within 1 year of diagnosis, the survival advantage for transplantation began earlier. Survival advantage for transplants was greater and
occurred earlier in patients with intermediate- and high-risk prognostic features than in those with low-risk features. This study
confirms higher early mortality, but a long-term survival advantage for
HLA-identical sibling transplants over hydroxyurea or interferon in
CML.
Blood, Vol. 91 No. 5 (March 1), 1998:
pp. 1810-1819
© 1998 by The American Society of Hematology.
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