VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

CHRONIC MYELOGENOUS LEUKEMIA WITH BAD PROGNOSTIC
FACTORS: AUTOLOGOUS BLOOD STEM CELL TRANSPLANTATION
FOLLOWED BY RECOMBINANT ALPHA INTERFERON
M. Montastruc, C. Faberes, J. Y. Cahn, V. Leblond, D. Caillot, G. Souillet,
J.D Tigaud, M. G. Marit, J. Reiffers.
Proceedings of the VI th
International Symposium on Autologous Bone Marrow
Transplantation. Houston (USA) December 1-3,1992
Correspondence: Professeur J. REIFFERS
Bone Marrow Transplant Unit
Hôpital Haut Leveque
33604 PESSAC - France
INTRODUCTION
Chronic Myelogenous Leukemia (CML) is a clonal myeloproliferative disorder
that progresses from a stable chronic phase lasting 3 to 4 years to a biastic
transformation which usually marks the terminal stage of the disease. Despite
encouraging results recently obtained with recombinant alpha interferonallogeneic
bone marrow transplantation (AlloBMT) remains the best means of eradicating
the malignant clone. However AlloBMT is only applicable to patients under
the age of 50 who have an HLA identical sibling donor, thus alternative
therapeutic strategies have to be proposed.
High-dose chemotherapy and/or radiotherapy followed by autologous
bone marrow transplantation (ABMT) was first used in 1974 by Buckner and al.
to treatment for patients with CML in transformation (2)
. The results of either
ABMT or autologous blood stem cell transplantation (ABSCT) for CML in transformation
reported in the 1980's can be summarized briefly as follows: a second
chronic phase can be achieved in most cases but its duration is usually very
short lasting approximately six months, and the benefit for survival is uncertain
or marginal (tai*,**»^
We report herein our results concerning 46 patients who underwent ABSCT
for CML in transformation. They were treated with a double autologous transplantation
of blood stem cells which was followed by alpha interferon treatment
(IFN) in order to prolong the duration of the second chronic phase. The encouraging
results observed in this series of patients prompted us to propose ABSCT
followed by IFN in patients with CML in chronic phase with poor prognostic
factors. The prehminary results are reported.
MATERIAL AND METHODS
CML in transformation (Group I)
Twenty-four adult patients (median age = 43 years; 27-64) were entered in
the study. Seventeen patients were in accelerated phase and 7 patients in blast
crisis. The interval time between diagnosis and transplantation was 40 months
(median: 4-159). The conditioning regimen used for the first transplantation was:
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 205