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

DISCUSSION
In this study, the use of intensive conditioning chemotherapy followed by
autologous blood stem cell transplantation was associated with a high response
rate in 95.8% Group I patients with a median survival of 20 months (1-73
months) and in 90% Group II patients with a median survival of 25.7 months
(16-48 months). As few toxic deaths were observed in these groups and a complete
hematopoietic reconstitution was achieved, we conclude that ABSCT is
feasible in high risk CML.
The major problem of autograffing for CML in transformation is the short
duration of the second chronic phase. Most of the studies reported results observed
in patients who underwent a single transplantation after many different
conditioning regimens which may or may not include total body irradiation.
The median second chronic phase duration was generally very short (4-6
months) due to the rapid recurrence of clonogenic blast cells implicated in the
initial transformation (3)
. The results in our present study seem to be encouraging
as the median survival was 20 months with 7 patients still alive 3 to 73 months
after ABSCT (median 28 months). It is difficult to know if these good results observed
in group I patients were due to the double autograft of the addition of
IFN after transplant. In a series of 51 patients. Haines et al. reported that the median
survival was significantly longer for patients who received a double transplantation
(52 weeks versus 13 weeks) (5)
. We reported similar results in a series
of 47 patients as the second chronic phase was noticeably longer in the 17 patients
who underwent a double transplant followed by IFN than that we observed
for 30 other patients who received a single or a double autograft without
IFN (6)
.
For the Group II patients, the results are also encouraging since most patients
achieved partial or CHR. These patients presented bad prognostic factors
suggesting that alpha-IFN would not be efficient if administered without
ABSCT. The annual transformation rate seems to be lower than that usually encountered
in high risk CML patients