Prognostic Factors for Allotransplantation in CML.

The role of hematopoietic cell transplantation in the treatment of chronic myelogenous leukemia (CML) has changed dramatically as the effectiveness of Gleevec has become clearer. The use of transplantation as first-line therapy and the timing of transplantation in those who do not achieve cytogenetic remission varies between centers. In order to better understand the likelihood of success following transplantation, we have analyzed prognostic factors in 126 patients with chronic phase CML who underwent allogeneic transplantation between 1984 and 2004. Median age was 37 (range 14–66). There were 69 males and 57 females. The interval between diagnosis and transplantation was most closely associated with survival in multivariate Cox analysis (P<.001). Interval was significant when analyzed as a continuous variable; also patients transplanted within 3 months experienced significantly longer survival than those > 3 months and patients less than 1 year from diagnosis had better survival than those more than 1 year from diagnosis. (P<.001). Patients with fully matched sibling donors experienced significantly better survival that those with other donors (P=.01). Treatment with Interferon or Gleevec, age, use of peripheral blood cells vs marrow, and year of transplant were not significant prognostic factors. There is no evidence that age, which is often heavily considered in determining timing of transplantation, is a significant prognostic factor in patients with CML undergoing allogeneic transplantation after busulfan and cyclophosphamide.

Because interval between diagnosis and transplantation significantly affects outcome, allogeneic transplantation should be considered early in patients receiving Gleevec when an adequate cytogenetic response is not achieved or at the first sign of relapse. Earlier identification of failure, e.g. using quantitative PCR for Bcr-Abl, might improve outcome and should be studied.