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Blood, 15 December 2007, Vol. 110, No. 13, pp. 4618-4619. This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hehlmann, R. Articles by Heimpel, H. Search for Related Content PubMed Articles by Hehlmann, R. Articles by Heimpel, H. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CORRESPONDENCE Response: Drug treatment and allografting as first-line therapy in young patients with CML Thanks for your comment on our report.1 Indeed, there is no rule without exceptions. We agree and have already stated in our report that patients' preference, very low transplantation risk, and economic reasons may be possible exceptions. Transplantation-related mortality and years lost due to transplantation weigh heavily also in very young patients. Published data do not support the notion that this patient group has a lower risk of transplantation-related mortality. Early mortality rates for chronic phase children in recent series range around 20%.2–4 In addition, the 14 patients younger than 20 years in our study provide no evidence that these patients are different from the rest of the study population (1 each of 5 transplanted and of 9 drug-treated patients died). A definite cure by allografting is not supported by long-term observations, which report a relapse rate of 1% per year.5 Although allografting has improved in recent years due to better patient selection, better HLA-typing, better donor availability, and better supportive care, drug treatment has also improved to a 5-year survival rate of 89% under imatinib with no serious late toxicities observed thus far.6 Considering the development of even more efficacious drugs, the prospects of long-term survival with modern drug treatment have to be weighed against early mortality after allografting. Allografting has to be discussed after imatinib failure or suboptimal response. At present, there is no indication that the years of life lost due to transplantation are compensated later on. The prospects of allografting also in young patients will depend on how much early mortality is accepted by patients in the face of alternative treatments with potentially better long-term perspectives.    Authorship Top Authorship References   Conflict-of-interest disclosure: The authors declare no competing financial interests. Correspondence: Rüdiger Hehlmann, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany; e-mail:r.hehlmann{at}urz.uni-heidelberg.de. Rüdiger Hehlmann, Alois Gratwohl, Markus Pfirrmann, Jörg Hasford, Andreas Hochhaus, Dieter K. Hossfeld, and Hermann Heimpel    References Top Authorship References   Hehlmann R, Berger U, Pfirrmann M, et al. Drug treatment is superior to allografting as first line therapy in chronic myeloid leukemia. Blood 2007; 109:4686–4692.[Abstract/Free Full Text] Cwynarski K, Roberts IA, Iacobelli S, et al. Stem cell transplantation for chronic myeloid leukemia in children. Blood 2003; 102:1224–1231.[Abstract/Free Full Text] Millot F, Esperou H, Bordigoni P, et al. Allogeneic bone marrow transplantation for chronic myeloid leukemia in childhood: a report from the Societe Francaise de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC). Bone Marrow Transplant 2003; 32:993–999.[CrossRef][Medline] [Order article via Infotrieve] Suttorp M, Claviez A, Martiniak Y, et al. Treatment results of chronic myeloid leukemia in childhood and adolescence [abstract]. Onkologie 2005; 28:suppl. 3, 149.[CrossRef] Gratwohl A, Brand R, Apperley J, et al. Allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia in Europe 2006: transplant activity, long-term data and current results. An analysis by the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Haematologica 2006; 91:513–521.[Abstract/Free Full Text] Druker BJ, Guilhot F, O'Brien S, 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] CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: No more transplantation in CML? Timothy Littlewood, Ram Malladi, and Andrew Peniket Blood 2007 110: 4618. [Full Text] [PDF] 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 Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hehlmann, R. Articles by Heimpel, H. Search for Related Content PubMed Articles by Hehlmann, R. Articles by Heimpel, H. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?

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