autologous blood and marrow transplantation - Blog Science ...

Allocation:
suitable for
transplantation,
consent?
Hehlmannetal. 121
German CML-Studv III A
Alio BMT
Figure 4. Study scheme of CML Study III A.
High dose chemotherapy
Autografting
related mortality considerably exceeds mortality in IFN-treated patients during the
first years after diagnosis. Only in the long term will BMT patients have a survival
advantage. No studies exist thus far that prospectively quantify risks and chances
of treatment by BMT vs. IFN. A simulation of possible outcomes was undertaken
by the IBMTR and the German CML Study Group. 30
The results showed that a
survival advantage for most BMT patients became significant after about 4-8
years. Only for low-risk IFN- or HU-treated patients a significant survival
advantage of BMT was not observable by year 8.
A prospective controlled comparison therefore was started in 1995 as part of
CML Studies III and III A. About 725 patients have been recruited for this
comparison within the two studies by now, and about 150 have been transplanted.
After a follow-up of about 2.5 years, IFN has a survival advantage, but it can be
Table 7. Superiority of early therapy in CML
• Allogeneic BMT, survival advantage after early BMT (Clift et al., 1993 43
; Goldman et
al., 1993 44
; Clift and Storb, 1996 45
)
• IFN-a superior in early CML (Alimena et al., 1988 46
; Talpaz et al., 1988 47
; Hasford et
al., 1996 10
)
• Mobilization of Ph-negative progenitor cells in early chronic phase (Carella et al.,
1996 48
)
• Chemotherapy, cytogenetic responses in (early) chronic phase (Cunningham et al.,
1979 27
; Sharp et al., 1979 28
)
• Intensified hydroxyurea treatment, cytogenetic responses in early chronic phase (Kolitz
et al., 1992 29
; Johnson et al., 1996 49
; Coutinho et al., 1996 50
)