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Blood, Vol. 94 No. 11 (December 1), 1999:
pp. 3668-3677
Interferon- Before Allogeneic Bone Marrow Transplantation in Chronic
Myelogenous Leukemia Does Not Affect Outcome Adversely, Provided It Is
Discontinued at Least 90 Days Before the Procedure
Rüdiger Hehlmann,
Andreas Hochhaus,
Hans-Jochem Kolb,
Jörg Hasford,
Alois Gratwohl,
Hermann Heimpel,
Wolfgang Siegert,
Jürgen Finke,
Gerhard Ehninger,
Ernst Holler,
Ute Berger,
Markus Pfirrmann,
Alexander Muth,
Axel Zander,
Axel A. Fauser,
Axel Heyll,
Christoph Nerl,
Dieter K. Hossfeld,
Helmut Löffler,
Hans Pralle, and
Wolfgang Queißer, and Andreas Tobler for the German CML-Study Group and the SAKK
From III. Medizinische Universitätsklinik,
Klinikum Mannheim, Universität Heidelberg,
Heidelberg, Germany; Biometrisches Zentrum,
München, München, Germany; and III.
Medizinische Klinik, Klinikum Großhadern, München,
Germany.
The influence of interferon- (IFN) pretreatment on the outcome
after allogeneic bone marrow transplantation (BMT) in chronic myelogenous leukemia (CML) is controversial. One goal of the German randomized CML Studies I and II, which compare IFN ± chemotherapy versus chemotherapy alone, was the analysis of whether treatment with
IFN as compared to chemotherapy had an influence on the outcome after
BMT. One hundred ninety-seven (23%) of 856 Ph/bcr-abl-positive CML
patients were transplanted. One hundred fifty-two patients transplanted
in first chronic phase were analyzed: 86 had received IFN, 46 hydroxyurea, and 20 busulfan. Forty-eight patients (32%) had received
transplants from unrelated donors. Median observation time after BMT
was 4.7 (0.7 to 13.5) years. IFN and chemotherapy cohorts were compared
with regard to transplantation risks, duration of treatments, interval
from discontinuation of pretransplant treatment to BMT, conditioning
therapy, graft-versus-host disease prophylaxis and risk profiles at
diagnosis and transplantation, and IFN cohorts also
with regard to performance and resistance to IFN. Outcome of patients
receiving related or unrelated transplants pretreated with IFN,
hydroxyurea, or busulfan was not significantly different. Five-year
survival after transplantation was 58% for all patients (57% for IFN,
60% for hydroxyurea and busulfan patients). The outcome within the IFN
group was not different by duration of prior IFN therapy more or less
than 5 months, 1 year, or 2 years. In contrast, a different impact was
observed in IFN-pretreated patients depending on the time of
discontinuation of IFN before transplantation. Five-year survival was
46% for the 50 patients who received IFN within the last 90 days
before BMT and 71% for the 36 patients who did not
(P = .0057). Total IFN dosage had no impact on survival
after BMT. We conclude that outcome after BMT is not compromised by
pretreatment with IFN if it is discontinued at least 3 months before
transplantation. Clear candidates for early transplantation should not
be pretreated with IFN.
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