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Blood, 1 June 2007, Vol. 109, No. 11, pp. 4592. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Guilhot, F. Search for Related Content PubMed Articles by Guilhot, F. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Comment on Hehlmann et al, page 4686 No more transplantation in CML? François Guilhot CENTRE HOSPITALIER UNIVERSITAIRE LA MILETRIE Allogeneic stem cell transplantation has been considered the only curative therapy for chronic myeloid leukemia (CML). However, since 1999 the number of transplantations reported to scientific groups has substantially dropped. In this issue, Hehlmann and colleagues report the results of a large randomized study comparing allogeneic stem cell transplantation versus the best available drug treatment. Of 621 patients included in the study, 354 were eligible for stem cell transplantation and 135 patients actually received a matched transplant. The patients included in the group that did not undergo transplantation were treated with interferon and hydroxyurea, or low-dose AraC and then with imatinib at the time the drug was available. The results of this important study demonstrate the superiority of the drug treatment group with a significantly better outcome. The difference is marked at 3 years after diagnosis, the 2 curves being indistinguishable at 8 years. There has been substantial progress in recent years in the management of CML with the remarkable efficacy of imatinib. Before the imabinib era, the treatment of CML patients was restricted to allogeneic stem cell transplantation or interferon-based regimen. These therapies were indicated in the majority of patients younger than 70 years. Allogeneic transplantation was considered for patients younger than 40 years for those with a matched related donor. Although the optimal timing of transplantation was frequently discussed, a number of papers have shown little difference in long-term outcome among patients who underwent transplantation in the first 12 months after diagnosis compared with those who underwent transplantation after 1 year. Although the procedure carries a risk of death, it is obvious that transplantation is still considered as the only curative therapy with patients in complete response without any maintenance therapy. Interferon (IFN)–based regimens are no longer used as front-line therapy. However, the combination of IFN and AraC has been considered the gold standard until imatinib demonstrated its superiority.1,2 Despite the toxicity of this combination, the treatment induced complete cytogenetic responses in patients who could tolerate 2 or 3 years of the treatment. Of interest, patients who achieved sustained cytogenetic responses had significant survival improvement. A similar observation has been published with imatinib. Given the recent update of the International Randomized Study of Interferon and STI 571 (IRIS) trial,2 it is obvious that any comparison between transplantation and imatinib would conclude in imatinib's favor. Allogeneic stem cell transplantation could again play a role in case of imatinib resistance. But the recent impressive results of the second generation of tyrosine kinase inhibitors3,4 will probably delay the time of transplantation in the course of the disease. However, these new inhibitors could also be used for reducing the tumor burden before performing stem cell transplantation. Nevertheless, the study of Hehlmann et al clearly reinforces the message previously published5 that allogeneic stem transplantation cannot be recommended for front-line therapy. Footnotes The author declares no competing financial interests. REFERENCES Guilhot F, Chastang C, Michallet M, et al. Interferon alfa-2b combined with cytarabine versus interferon alone in chronic myelogenous leukemia: French Chronic Myeloid Leukemia Study Group. N Engl J Med 1997; 337:223–229.[Abstract/Free Full Text] Druker BJ, Guilhot F, O'Brien SG, et al. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 2006; 355:2408–2417.[Abstract/Free Full Text] Hochhaus A, Kantarjian H, Baccarani M, et al. Dasatinib induces notable hematologic and cytogenetic responses in chronic-phase chronic myeloid leukemia after failure of imatinib therapy. Blood 2007; 109:2303–2309.[Abstract/Free Full Text] Kantarjian H, Giles F, Wunderle L, et al. Nilotinib in imatinib-resistant CML and Philadelphia chromosome-positive ALL. N Engl J Med 2006; 354:2542–2551.[Abstract/Free Full Text] Baccarani M, Saglio G, Goldman J, et al. Evolving concepts in the management of chronic myeloid leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood 2006; 108:1809–1820.[Abstract/Free Full Text] CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia Rüdiger Hehlmann, Ute Berger, Markus Pfirrmann, Hermann Heimpel, Andreas Hochhaus, Joerg Hasford, Hans-Jochem Kolb, Tanja Lahaye, Ole Maywald, Andreas Reiter, Dieter K. Hossfeld, Christoph Huber, Helmut Löffler, Hans Pralle, Wolfgang Queisser, Andreas Tobler, Christoph Nerl, Max Solenthaler, Mariele E. Goebeler, Martin Griesshammer, Thomas Fischer, Stephan Kremers, Hartmut Eimermacher, Michael Pfreundschuh, Wolf-Dietrich Hirschmann, Klaus Lechner, Barbara Wassmann, Christiane Falge, Hartmut H. Kirchner, and Alois Gratwohl, for the Schweizerische Arbeitsgemeinschaft für Klinische Krebsforschung (SAKK) and the German CML Study Group Blood 2007 109: 4686-4692. [Abstract] [Full Text] [PDF] This article has been cited by other articles: T. Littlewood, R. Malladi, and A. Peniket No more transplantation in CML? Blood, December 15, 2007; 110(13): 4618 - 4618. [Full Text] [PDF] This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Guilhot, F. Search for Related Content PubMed Articles by Guilhot, F. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?

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