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Unrelated donor bone marrow transplantation as treatment for chronic myeloid leukemia: the Spanish experience. The Chronic Myeloid Leukemia Subcommittee of the GETH. Grupo Español de Trasplante Hemopoyético.
Haematologica. 2000 May; 85(5):530-8.H

Abstract

BACKGROUND AND OBJECTIVE

To analyze the results of unrelated bone marrow transplantation (UDBMT) as treatment for chronic myeloid leukemia (CML) in Spain.

DESIGN AND METHODS

Eighty-seven consecutive UDBMT performed in 9 centers between October 1989 and February 1998 were evaluated. This represents more than 95% of UDBMT for CML performed in adult transplant centers in Spain during this period. The patients' median age was 31.5 years (range, 12-49). The median interval from CML diagnosis to UDBMT was 30 months (range, 3-160). Seventy-nine percent of transplants were performed during the first chronic phase (1CP).

RESULTS

Actuarial probability of survival and disease-free survival at 4 years for the whole series was 24% (95% confidence interval [CI]: 14%-34%) and 20% (CI: 10%-30%), respectively. The cumulative incidence of relapse and transplant-related mortality (TRM) was 7% (CI: 4%-10%) and 71% (CI: 60%-82%), respectively. The main causes of death were graft failure (n=7), infection (n=23), and graft-versus-host disease (GvHD) (n=25). The actuarial probability of acute GvHD grade II-IV and grade III-IV was 56% (CI:46%-66%) and 36% (CI: 26%-36%), respectively. The cumulative incidence of extensive chronic GvHD was 18% (CI: 9%-27%). Univariate analyses showed that the pre-transplant factor with the highest influence on survival was disease status at transplant (30% in 1CP vs. 0% in advanced phases; p=0.0001). Other pre-transplant factors influencing survival among patients in 1CP were: patient's age (older than 30 years 11% vs. 48%), interval diagnosis-transplantation (longer than 2 years 17% vs. 55%), donor type (HLA, B, DRB1 identical 32% vs. 25%), CMV serologic status (donor and recipient negative 63% vs. 24%), year of transplantation (before 1995 19% vs. 40%), and conditioning regimen (cyclophosphamide plus total body radiation 40% vs. 16%). The main risk factors had a cumulative effect on survival. Thus, probability of survival ranged from 66% (CI: 39%-93%) in patients in 1CP, under 40 years of age, transplanted from an HLA, A, B, DRB1 identical donor during the first two years after diagnosis, to 0% in those with three or more risk factors.

INTERPRETATION AND CONCLUSIONS

This experience shows that UDBMT used to have a high TRM that has progressively decreased along the years. At the present time, the results are encouraging, particularly when UDBMT is performed under favorable conditions.

Authors+Show Affiliations

BMT Section, Hematology Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain. carreras@clinic.ub.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10800172

Citation

Carreras, E, et al. "Unrelated Donor Bone Marrow Transplantation as Treatment for Chronic Myeloid Leukemia: the Spanish Experience. the Chronic Myeloid Leukemia Subcommittee of the GETH. Grupo Español De Trasplante Hemopoyético." Haematologica, vol. 85, no. 5, 2000, pp. 530-8.
Carreras E, Tomás JF, Sanz G, et al. Unrelated donor bone marrow transplantation as treatment for chronic myeloid leukemia: the Spanish experience. The Chronic Myeloid Leukemia Subcommittee of the GETH. Grupo Español de Trasplante Hemopoyético. Haematologica. 2000;85(5):530-8.
Carreras, E., Tomás, J. F., Sanz, G., Iriondo, A., Boqué, C., López, J., Cabrera, R., Sureda, A., de Soria, V. G., Sierra, J., Sanz, M. A., & Torres, A. (2000). Unrelated donor bone marrow transplantation as treatment for chronic myeloid leukemia: the Spanish experience. The Chronic Myeloid Leukemia Subcommittee of the GETH. Grupo Español de Trasplante Hemopoyético. Haematologica, 85(5), 530-8.
Carreras E, et al. Unrelated Donor Bone Marrow Transplantation as Treatment for Chronic Myeloid Leukemia: the Spanish Experience. the Chronic Myeloid Leukemia Subcommittee of the GETH. Grupo Español De Trasplante Hemopoyético. Haematologica. 2000;85(5):530-8. PubMed PMID: 10800172.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unrelated donor bone marrow transplantation as treatment for chronic myeloid leukemia: the Spanish experience. The Chronic Myeloid Leukemia Subcommittee of the GETH. Grupo Español de Trasplante Hemopoyético. AU - Carreras,E, AU - Tomás,J F, AU - Sanz,G, AU - Iriondo,A, AU - Boqué,C, AU - López,J, AU - Cabrera,R, AU - Sureda,A, AU - de Soria,V G, AU - Sierra,J, AU - Sanz,M A, AU - Torres,A, PY - 2000/5/9/pubmed PY - 2000/9/2/medline PY - 2000/5/9/entrez SP - 530 EP - 8 JF - Haematologica JO - Haematologica VL - 85 IS - 5 N2 - BACKGROUND AND OBJECTIVE: To analyze the results of unrelated bone marrow transplantation (UDBMT) as treatment for chronic myeloid leukemia (CML) in Spain. DESIGN AND METHODS: Eighty-seven consecutive UDBMT performed in 9 centers between October 1989 and February 1998 were evaluated. This represents more than 95% of UDBMT for CML performed in adult transplant centers in Spain during this period. The patients' median age was 31.5 years (range, 12-49). The median interval from CML diagnosis to UDBMT was 30 months (range, 3-160). Seventy-nine percent of transplants were performed during the first chronic phase (1CP). RESULTS: Actuarial probability of survival and disease-free survival at 4 years for the whole series was 24% (95% confidence interval [CI]: 14%-34%) and 20% (CI: 10%-30%), respectively. The cumulative incidence of relapse and transplant-related mortality (TRM) was 7% (CI: 4%-10%) and 71% (CI: 60%-82%), respectively. The main causes of death were graft failure (n=7), infection (n=23), and graft-versus-host disease (GvHD) (n=25). The actuarial probability of acute GvHD grade II-IV and grade III-IV was 56% (CI:46%-66%) and 36% (CI: 26%-36%), respectively. The cumulative incidence of extensive chronic GvHD was 18% (CI: 9%-27%). Univariate analyses showed that the pre-transplant factor with the highest influence on survival was disease status at transplant (30% in 1CP vs. 0% in advanced phases; p=0.0001). Other pre-transplant factors influencing survival among patients in 1CP were: patient's age (older than 30 years 11% vs. 48%), interval diagnosis-transplantation (longer than 2 years 17% vs. 55%), donor type (HLA, B, DRB1 identical 32% vs. 25%), CMV serologic status (donor and recipient negative 63% vs. 24%), year of transplantation (before 1995 19% vs. 40%), and conditioning regimen (cyclophosphamide plus total body radiation 40% vs. 16%). The main risk factors had a cumulative effect on survival. Thus, probability of survival ranged from 66% (CI: 39%-93%) in patients in 1CP, under 40 years of age, transplanted from an HLA, A, B, DRB1 identical donor during the first two years after diagnosis, to 0% in those with three or more risk factors. INTERPRETATION AND CONCLUSIONS: This experience shows that UDBMT used to have a high TRM that has progressively decreased along the years. At the present time, the results are encouraging, particularly when UDBMT is performed under favorable conditions. SN - 0390-6078 UR - https://www.unboundmedicine.com/medline/citation/10800172/Unrelated_donor_bone_marrow_transplantation_as_treatment_for_chronic_myeloid_leukemia:_the_Spanish_experience__The_Chronic_Myeloid_Leukemia_Subcommittee_of_the_GETH__Grupo_Español_de_Trasplante_Hemopoyético_ L2 - http://www.diseaseinfosearch.org/result/1622 DB - PRIME DP - Unbound Medicine ER -