Abstract
A total of 24 patients (median age 58; range, 27–71 years) with chronic myeloid leukemia (CML) in first chronic (CP1) (n=14), second chronic (n=4), or accelerated phase (n=6) who were not candidates for conventional hematopoietic cell transplantation (HCT), received nonmyeloablative HCT from HLA-matched siblings a median of 28.5 (range, 11–271) months after diagnosis. They were conditioned with 2 Gy total body irradiation (TBI) alone (n=8) or combined with fludarabine, 90 mg/m2 (n=16). Postgrafting immunosuppression included cyclosporine and mycophenolate mofetil. All patients initially engrafted. However, 4 of 8 patients not given fludarabine experienced nonfatal rejection while all others had sustained engraftment. With a median follow-up of 36 (range, 4–49) months, 13 of 24 patients (54%) were alive and in complete remission. There were five (21%) deaths from nonrelapse mortality, one (4%) during the first 100 days after transplant. The proportions of grade II, III, and IV acute GVHD were 38, 4, and 8%, respectively. The 2-year estimate of chronic GVHD was 32%. The 2-year survival estimates for patients in CP1 (n=14) and beyond CP1 (n=10) were 70 and 56%, respectively. This study shows encouraging remission rates for patients with CML not eligible for conventional allografting.
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Acknowledgements
We thank the physicians, nurses, and support staff of the collaborating centers for their dedicated patient care. We are also grateful to the study nurses Steve Minor, John Sedgwick, Mary Hinds, and the data coordinators Heather Hildebrant, Debbie Bassuk and Lucy Fetzko who made this analysis possible. We are grateful to Bonnie Larson and Helen Crawford for help with manuscript preparation. This work is supported in part by NIH Grants: CA78902, CA49605, CA18029, CA15704, Bethesda, MD, the European Leukemia Net, the Kompetenznetzwerk Akute und chronische Leukämien, and from a grant from Ministero dell'Istruzione, dell'Università, della Ricerca (MIUR), Italy. FR Kerbauy is supported by a grant from FAPESP/Brazil and an award from the Oncology Research Faculty Development Program from the Department of Health and Human Services, NIH, Bethesda, MD.
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Kerbauy, F., Storb, R., Hegenbart, U. et al. Hematopoietic cell transplantation from HLA-identical sibling donors after low-dose radiation-based conditioning for treatment of CML. Leukemia 19, 990–997 (2005). https://doi.org/10.1038/sj.leu.2403730
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DOI: https://doi.org/10.1038/sj.leu.2403730
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