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Blood, Vol. 95 No. 7 (April 1), 2000:
pp. 2219-2225
Unrelated donor marrow transplantation for chronic myelogenous
leukemia: 9 years' experience of the National Marrow Donor Program
Philip B. McGlave,
Xiao Ou Shu,
Wanqing Wen,
Claudio Anasetti,
Auayporn Nademanee,
Richard Champlin,
Joseph H. Antin,
Nancy A. Kernan,
Roberta King, and
Daniel J. Weisdorf
From the University of Minnesota at Minneapolis, MN;
the National Marrow Donor Program, Minneapolis, MN; the University of
South Carolina, Columbia, SC; Fred Hutchinson Cancer Research Center,
Seattle, WA; Dana Farber/Partners Cancer Care, Boston, MA; City of Hope
National Medical Center, Duarte, CA; M.D. Anderson Cancer Center,
Houston, TX; and Memorial Sloan-Kettering Cancer Center, New York, NY.
Over a period of 8.5 years (February 1988 to October 1996),
1423 patients with chronic myelogenous leukemia (CML) underwent unrelated donor (URD) bone marrow transplants (BMTs) facilitated by the
National Marrow Donor Program (NMDP) at 85 transplant centers. One
hundred thirty-seven evaluable (9.9%) patients failed to
engraft, and an additional 83 (6.6%) evaluable patients
experienced late graft failure. Grade III/IV acute graft-versus-host
disease (GVHD) developed in 33% of patients (95% confidence interval
[CI], 30%-36%). The incidence of extensive chronic GVHD was 60%
(95% CI, 56%-63%) at 2 years. Only 5.7% of patients (95% CI,
3.6%-7.8%) transplanted in chronic phase developed hematologic
relapse at 3 years. Several factors were independently associated with
improved disease-free survival (DFS), including transplant in chronic
phase, transplant within 1 year of diagnosis, younger recipient age, a
cytomegalovirus seronegative recipient, and development of no or mild
acute GVHD. The combined effect of these factors on outcome is manifest
in a subset (n = 157) of young (less than 35 years), chronic phase patients transplanted within 1 year of diagnosis using HLA-matched donors who had 63% (95% CI, 53%-73%) DFS at 3 years. URD
BMT therapy for CML is both feasible and effective with
more frequent and more rapid identification of suitable donors.
Early URD transplant during chronic phase yields good
results and should be considered in CML patients otherwise
eligible for transplant but without a suitable related donor.
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