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Blood, 1 April 2002, Vol. 99, No. 7, pp. 2304-2309
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Factors affecting duration of survival after onset of blastic
transformation of chronic myeloid leukemia
Jyoti Wadhwa,
Richard M. Szydlo,
Jane F. Apperley,
Andrew Chase,
Marco Bua,
David Marin,
Eduardo Olavarria,
Edward Kanfer, and
John M. Goldman
From the Department of Haematology, Hammersmith
Hospital and Faculty of Medicine, Imperial College, London, United
Kingdom.
We analyzed factors having an impact on response to treatment and
survival in 78 consecutive patients with chronic myeloid leukemia (CML)
in blastic transformation (BT) referred to the Hammersmith Hospital
from January 1995 to December 2000. BT was defined as the presence of
at least 30% blasts in blood or marrow or extramedullary blastic
deposits. Immunophenotyping of blasts showed 57 myeloid, 19 lymphoid,
and 2 biphenotypic. The median age of the patients was 39.1 years
(range, 11.3-73.4 years), with 55 males and 23 females. The median
survival for all patients after onset of BT was 8.2 months (95% CI,
6.4-10). Patients in lymphoid BT survived longer than those in myeloid
BT (median, 11.2 months versus 6.9 months, P = .052).
Initial treatment varied; 41 patients received cytotoxic drugs, 8 underwent allogeneic or autologous transplantation
procedures, 21 received STI571 (imatinib mesylate,
Gleevec), 1 received radiotherapy, and 7 received no therapy.
Of the 25 (32%) patients who achieved a "second chronic phase"
with first therapy, 6 of 21 (29%) were treated with STI571 and 19 of
50 (38%) were treated with chemotherapy, transplantation, or
radiotherapy. Patients who achieved a second chronic phase survived longer than those who did not (median time from onset of BT
12.0 months versus 6.3 months, P = .0004). In
multivariate analysis the finding of more than 50% blast cells in the
blood and the presence of cytogenetic progression were independent
adverse prognostic variables for survival. We conclude that survival
after onset of BT has improved in recent years but is still
unsatisfactory. We speculate that the combined use of STI571 with
cytotoxic drugs may offer additional benefit.
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