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Blood, Vol. 96 No. 1 (July 1), 2000:
pp. 86-90
Estimating leukemia-free survival after allografting for chronic
myeloid leukemia: a new method that takes into account patients who
relapse and are restored to complete remission
Charles Craddock,
Richard M. Szydlo,
John P. Klein,
Francesco Dazzi,
Eduardo Olavarria,
Frits van Rhee,
Christopher Pocock,
Kate Cwynarski,
Jane F. Apperley, and
John M. Goldman
From the Leukaemia Research Fund Centre for Adult Leukaemia,
Hammersmith Hospital, London, England, and the Division of
Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
A significant number of patients who relapse after allogeneic stem
cell transplantation (SCT) for chronic myeloid leukemia (CML) will
achieve sustained remissions after treatment with interferon- , second transplants, or donor lymphocyte infusions (DLI) from the original stem cell donor. Because leukemia-free survival (LFS) is at
present defined as survival without evidence of relapse at any time
posttransplant, patients who relapse but are then restored to complete
remission are treated as failures when estimating LFS. We have
established a new category of LFS, termed current LFS (CLFS), which we
define as survival without evidence of leukemia at the time of most
recent assessment. To gauge the contribution of treatment for
relapse to the efficacy of allogeneic SCT in the management of CML in
chronic phase, we compared conventional LFS and CLFS in 189 consecutive
patients who underwent SCT over a 7-year period with a minimum
follow-up of 3 years. Patients with sibling donors (n = 111)
received cyclosporine and methotrexate as prophylaxis for graft versus
host disease; patients with unrelated donors (n = 78) also received
Campath-1G or 1H as intravenous T-cell depletion. The 5-year LFS
defined conventionally was 36% (CI: 29% to 43%) versus a 5-year CLFS
of 49% (CI: 36% to 62%). This new method of defining LFS confirms
the view that appropriate "salvage" therapy, principally DLI,
makes a major contribution to the capacity of allogeneic SCT to produce
long-term LFS in patients who receive SCT for CML and emphasizes the
importance of redefining LFS to take account of successful treatment of relapse.
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