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122 Chapter 3: CML
Table 8. Survival of CML after BMT and IFN
Proportion surviving
3 years 5 years 10 years
BMT (early) 66-75% 50-75% 50-65%
IFN
Low-risk 95% 75% 45%
Intermediate- and high-risk 80% 50% 20%
Data from Hansen et al. 52
; Tura et al. 6
; Appelhaum et al. 53
; van Rhee et al. 54
; German
CML Study Group. 950
expected that the survival curves of IFN-treated and transplanted patients will cross
soon. The observation period is still too short for a risk-stratified analysis.
DISCUSSION
In summary, a considerable advance has been made with survival in CML after
both BMT and drug treatment. Table 8 gives an overview of the survival rates after
3, 5, and 10 years based on published reports. 6
' 9,31,32
The perspectives for the future
include new experimental strategies such as high-dose chemotherapy and
autografting with early stem cell harvest as outlined above, evaluation of new active
drugs, and the optimization of allogeneic BMT procedures. The German CML
Studies III and III A are expected to provide contributions to some of these
perspectives. Outcome of CML Study III A will depend on the feasibility of the study
protocol in hematologic practice, on sufficient numbers of recruited and autotransplanted
patients within a reasonable time period, and on availability and success of
alternative treatment approaches. If recruitment proceeds as planned, the required
patient number would be reached in 2003, and initial results based on surrogate
markers (hematologic and cytogenetic responses) could be available in 2004.
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