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Blood, 1 November 2007, Vol. 110, No. 9, pp. 3456-3462. Prepublished online as a Blood First Edition Paper on July 25, 2007; DOI 10.1182/blood-2007-04-085969.
Submitted April 17, 2007
Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX * Corresponding author; email: pkebriae{at}mdanderson.org.
Allogeneic hematopoietic stem cell transplantation (HSCT) remains an effective strategy for inducing durable remission in chronic myeloid leukemia (CML). Reduced intensity conditioning (RIC) regimens extend HSCT to older patients and those with co-morbidities who would otherwise not be suitable candidates for HSCT. The long-term efficacy of this approach is not established. We evaluated outcomes of 64 CML patients with advanced phase disease (80% beyond first chronic phase), not eligible for myeloablative preparative regimens due to older age or co-morbid conditions, who were treated with fludarabine-based RIC regimens. Donor type was matched related (n=30), 1 antigen mismatched related (n=4), or matched unrelated (n=30). With median follow-up of 7 years, overall- (OS) and progression-free survival (PFS) were 33% and 20%, respectively, at 5 years. Incidence of treatment-related mortality (TRM) was 33%, 39%, and 48% at 100 days, 2- and 5-years post HSCT. In multivariate analysis, only disease stage at time of HSCT was significantly predictive for both OS and PFS. RIC HSCT provides adequate disease control in chronic phase CML patients, but alternative treatment strategies need to be explored in patients with advanced disease. TRM rates are acceptable in this high-risk population but increase over time.
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