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Association Between Pretransplant Interferon- and Outcome After
Unrelated Donor Marrow Transplantation for Chronic Myelogenous
Leukemia in Chronic Phase
A. James Morton,
Ted Gooley,
John A. Hansen,
Frederick R. Appelbaum,
Barbara Bruemmer,
Jean W. Bjerke,
Reg Clift,
Paul J. Martin,
Effie W. Petersdorf,
Jean E. Sanders,
Rainer Storb,
Keith M. Sullivan,
Ann Woolfrey, and
Claudio Anasetti
From the Fred Hutchinson Cancer Research Center and the University of
Washington, Seattle, WA.
Treatment options for patients diagnosed with chronic myelogenous
leukemia (CML) in chronic phase (CP) who lack a suitable related donor
for marrow transplantation include hydroxyurea, interferon-
(IFN-), or transplantation from an unrelated donor (URD). Most
studies support the view that treatment with IFN- results in
prolonged survival compared with hydroxyurea therapy. Some patients are
offered URD transplantation as a second-line treatment; however, the
impact of pretransplant IFN- on the outcome of URD transplantation
is uncertain. To address this question, we evaluated the effect of
pretransplant IFN- therapy in 184 patients undergoing URD
transplantation for CML in CP at a single center. Of the 184 patients,
114 did not receive IFN-, whereas 22, 23, and 25 patients received
IFN- for, respectively, 1 to 5, 6 to 12, and more than 12 months
before transplant. Pretransplant IFN- therapy administered for  6
months was associated with an increased risk of severe (grades III-IV)
acute graft-versus-host disease (GVHD; relative risk [RR], 3.0; 95%
confidence interval [CI], 1.4 to 6.2; P = .004) and
mortality (RR, 2.1; 95% CI, 1.3 to 3.5; P = .003) relative
to less than 6 months or no IFN- therapy. Increased mortality
occurred between 100 and 365 days after transplant (P = .005), was limited to patients with severe acute GVHD, and was due to
chronic GVHD refractory to immunosuppressive therapy. Other variables
associated with mortality included HLA-DRB1 or DQB1 (but not HLA-A or
B) mismatched donors, age greater than 50 years, weight 110% of
ideal body weight, and the absence of cytomegalovirus (CMV) or fungal
prophylaxis. For patients treated with IFN- for less than 6 months
before transplant, who were  50 years of age, received a HLA-A, B,
DRB1, and DQB1 matched URD transplant, and received CMV and fungal
prophylaxis after transplant (n = 48), survival was 87% ± 5% at 5 years. These data provide a rationale for immediate transplantation in
preference to extended treatment with IFN- when the patient is 50
years of age and has an HLA-compatible unrelated volunteer donor.
Blood, Vol. 92 No. 2 (July 15), 1998:
pp. 394-401
© 1998 by the American Society of Hematology.
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