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Blood, Vol. 95 No. 11 (June 1), 2000:
pp. 3328-3334
Risk assessment in patients with Ph+ chronic
myelogenous leukemia at first relapse after allogeneic stem cell
transplant: an EBMT retrospective analysis
Cesare Guglielmi,
William Arcese,
Jo Hermans,
Andrea Bacigalupo,
Giuseppe Bandini,
Donald Bunjes,
Enric Carreras,
Agnès Devergie,
Francesco Frassoni,
John Goldman,
Alois Gratwohl,
Hans-Jochem Kolb,
Anna P. Iori,
Dietger Niederwieser,
H. Grant Prentice,
Theo de Witte, and
Jane Apperley for the Chronic Leukemia
Working Party of the European Group for Blood and Marrow
Transplantation
From the Università "La Sapienza," Dipartimento di
Biotecnologie Cellulari ed Ematologia, Unità TMO Allogenico
"Giuseppe Papa," Roma, Italy; Department of Medical Statistics,
Leiden University Medical Center, Leiden, The Netherlands; Department
of Hematology, Ospedale S. Martino, Genova, Italy; Institute of
Hematology and Clinical Oncology Seragnoli, Hospital Sant'Orsola,
Bologna, Italy; Abt. Innere Medizin III, Universitat Ulm, Ulm, Germany;
BMT Section, Department of Hematology, Hospital Clinic, IDIBAPS,
Barcelona, Spain; Department of Hematology-BMT, Hopital St Louis,
Paris, France; Department of Hematology, Imperial College School of
Medicine at the Hammersmith Hospital, London, England; Department of
Internal Medicine, Division of Hematology, Kantonsspital, Basel,
Switzerland; Klinikum Grosshadern, Med. Klinik III, Munchen, Germany;
Center of Internal Medicine, Department of Hematology/Oncology,
University of Leipzig, Leipzig, Germany; Department of Hematology,
Royal Free and University College Medical School, London, England; and
the Division of Hematology, University Hospital St Radboud, Nijmegen,
The Netherlands.
Patients with Ph+ chronic myelogenous leukemia who relapse after a
first allogeneic stem cell transplant still have a possibility of
long-term survival. To assess the value of the individual therapeutic options, the factors predicting outcome should be identified. We
investigated data from 500 patients who relapsed before July 1996;
follow-up was updated during 1998. The actuarial survival from relapse
was 34.2% (95% confidence interval [CI]: 29.9%-38.5%) at 5 years
and 23.4% (95% CI: 18.9%-27.9%) at 10 years. Survival after
relapse was significantly related to 5 factors: time from diagnosis to
transplant (< 2 years vs  2 years), disease phase at transplant
(first chronic phase vs other), disease stage at relapse (cytogenetic
or chronic phase vs advanced phase), time from transplant to relapse
(< 1 year vs 1 year), and donor type (HLA-identical sibling vs
volunteer unrelated donor). The effects of individual adverse risk
factors were cumulative: The probability of survival at 10 years
decreased stepwise from 42% (0 factors), 32% (1 factor), 14% (2 factors), 3% (3 factors), to 0% (4 or 5 factors). Novel strategies
for high-risk patients are warranted. We conclude that these 5 factors
should be taken into account when comparing results of salvage
therapies in patients with Ph+ chronic myeloid leukemia relapsing
after allogeneic stem cell transplant.
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