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Blood, 1 December 2001, Vol. 98, No. 12, pp. 3205-3211
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
The effect of pretransplant interferon therapy on the outcome of
unrelated donor hematopoietic stem cell transplantation for patients
with chronic myelogenous leukemia in first chronic phase
Stephanie J. Lee,
John P. Klein,
Claudio Anasetti,
Joseph H. Antin,
Fausto R. Loberiza,
Brian J. Bolwell,
Charles F. LeMaistre,
Mark R. Litzow,
David Marks,
Edmund K. Waller,
Marie Matlack,
Sergio Giralt, and
Mary M. Horowitz
From the Chronic Leukemia Working Committee of the
International Bone Marrow Transplant Registry, Health Policy Institute,
Medical College of Wisconsin, Milwaukee, WI; Coordinating Center of the
National Marrow Donor Program, Minneapolis, MN; Dana-Farber Cancer
Center, Boston, MA; Fred Hutchinson Cancer Center, Seattle, WA;
Cleveland Clinic Foundation, Cleveland, OH; South Texas Cancer
Institute, San Antonio, TX; Mayo Clinic and Foundation, Rochester, MN;
Bristol Children's Hospital, Bristol, United Kingdom; and M. D. Anderson Cancer Center, Houston, TX.
Various therapeutic options are available for patients with chronic
myelogenous leukemia. Allogeneic stem cell transplantation, though
often curative, is associated with high nonrelapse mortality and
long-term morbidity, particularly when cells from unrelated donors are
used. Many physicians and patients opt for a trial of interferon-
(IFN)-based therapy first, reserving transplantation for patients with
inadequate response or intolerance to IFN. Data were analyzed on 740 patients receiving unrelated donor transplants for chronic myelogenous
leukemia in first chronic phase provided by the International Bone
Marrow Transplant Registry and the National Marrow Donor Program to see
whether IFN pretreatment compromised transplantation outcome. A total
of 489 (66%) had received IFN prior to transplantation; 251 (34%) had
not. Disease characteristics in the 2 groups were similar at diagnosis
but at the time of transplantation, hematologic parameters and weight
were lower in IFN patients and the interval between diagnosis and
transplantation was longer. After adjustment for baseline covariates,
no effect of IFN exposure was found on overall survival, leukemia-free
survival, nonrelapse mortality, engraftment, relapse, or acute or
chronic graft-versus-host disease. Evaluation of effects based on
duration of therapy and time off IFN prior to transplantation was
limited by missing data and confounding with IFN intolerance and
disease responsiveness. In conclusion, no evidence was found for an
independent adverse effect of IFN pretreatment on the outcome of
subsequent unrelated donor transplantation.
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