Long-term follow-up of allogeneic bone marrow transplantation for patients with chronic phase chronic myeloid leukemia prepared with a regimen consisting of cyclophosphamide, cytarabine and single-dose total body irradiation conditioning

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 5; pp. 423 - 430
• Main Authors: ZARETSKY, Y, RIFKIND, J, MESSNER, H, LIPTON, J. H, LOCKWOOD, G, TSANG, R, KISS, T, HASEGAWA, W, FYLES, G, TEJPAR, I, LOACH, D, MINDEN, M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.09.2007
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - adverse effects; Bone Marrow Transplantation - methods; Bone Marrow Transplantation - mortality; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Chronic myeloid leukemia; Conditioning; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cytarabine; Cytarabine - administration & dosage; Cytogenetics; Cytosine; Female; Follow-Up Studies; Graft rejection; Graft vs Host Disease; Graft-versus-host reaction; Grafts; Health aspects; Hematologic and hematopoietic diseases; Humans; Imatinib; Irradiation; Leukemia; Leukemia, Myeloid, Chronic-Phase - complications; Leukemia, Myeloid, Chronic-Phase - mortality; Leukemia, Myeloid, Chronic-Phase - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocytes; Male; Medical sciences; Methods; Middle Aged; Myelocytic leukemia; Myeloid leukemia; Nonlymphoid leukemia; Radiation; Radiation dosage; Recurrence; Retrospective Studies; Salvage Therapy - methods; Stem cell transplantation; Survival; Survival Analysis; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplantation, Homologous; Transplants; Transplants & implants; Treatment Outcome; Veno-occlusive disease; Whole-Body Irradiation - methods; Canada; Antineoplastic agent; low-dose total-body irradiation; Stem cell; Hematopoietic cell; Homograft; allogeneic bone marrow transplant; Myeloproliferative syndrome; Cytarabine; Chronic myelocytic leukemia; Bone marrow; Graft; Antiviral; Conditioning; Pyrimidine nucleoside; Human; Total body irradiation; CML; Hematology; Low dose; Single dose; Malignant hemopathy; Long term; Alkylating agent; Oxazaphosphinane derivatives; Cyclophosphamide; Antimetabolic; Nitrogen mustard
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705755

We evaluated long-term toxicities and outcomes in 96 patients with chronic phase chronic myeloid leukemia treated with a single bone marrow allograft regimen. Conditioning was cytosine arabinoside, cyclophosphamide (120 mg/kg) and single fraction total body irradiation (500 cGy). Median follow-up was 12.8 years (0.4-19.9 years). Graft failure occurred in one patient, nonfatal veno-occlusive disease in 13 patients (14%). Overall incidences of acute (a) and chronic (c) graft-vs-host disease (GVHD) were 77 and 63%. The 100-day and 1-year transplant-related mortality (TRM) were 1 and 9.2%, respectively, with no change through 5 years. Five- and 10-year event-free survival rates were 56 and 49%, overall survival (OS) rates 72 and 70%, respectively. Forty patients have relapsed: 8 cytogenetic (20%), 10 hematologic (25%) and 22 molecular (55%). Most have been salvaged with donor-leukocyte infusion, second transplants and/or imatinib therapy. Survival was worse for patients transplanted >2 years from diagnosis (10-year OS 56 vs 78%, P=0.01), for patients over 50 years old (10-year OS 44 vs 75%, P=0.05) and for patients without cGVHD (10-year OS 53 vs 86%, P<0.001). This regimen resulted in successful engraftment, low risk of TRM and long-term survival. In an era when imatinib is first line therapy, this regimen offers a potentially low-toxicity, highly successful alternative in the event of poor imatinib response.