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Allografting

Long-term follow-up of allogeneic bone marrow transplantation for patients with chronic phase chronic myeloid leukemia prepared with a regimen consisting of cyclophosphamide, cytarabine and single-dose total body irradiation conditioning

Bone Marrow Transplantation volume 40, pages 423–430 (2007)Cite this article

Abstract

We evaluated long-term toxicities and outcomes in 96 patients with chronic phase chronic myeloid leukemia treated with a single bone marrow allograft regimen. Conditioning was cytosine arabinoside, cyclophosphamide (120 mg/kg) and single fraction total body irradiation (500 cGy). Median follow-up was 12.8 years (0.4–19.9 years). Graft failure occurred in one patient, nonfatal veno-occlusive disease in 13 patients (14%). Overall incidences of acute (a) and chronic (c) graft-vs-host disease (GVHD) were 77 and 63%. The 100-day and 1-year transplant-related mortality (TRM) were 1 and 9.2%, respectively, with no change through 5 years. Five- and 10-year event-free survival rates were 56 and 49%, overall survival (OS) rates 72 and 70%, respectively. Forty patients have relapsed: 8 cytogenetic (20%), 10 hematologic (25%) and 22 molecular (55%). Most have been salvaged with donor-leukocyte infusion, second transplants and/or imatinib therapy. Survival was worse for patients transplanted >2 years from diagnosis (10-year OS 56 vs 78%, P=0.01), for patients over 50 years old (10-year OS 44 vs 75%, P=0.05) and for patients without cGVHD (10-year OS 53 vs 86%, P<0.001). This regimen resulted in successful engraftment, low risk of TRM and long-term survival. In an era when imatinib is first line therapy, this regimen offers a potentially low-toxicity, highly successful alternative in the event of poor imatinib response.

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Acknowledgements

Preparation of this manuscript was funded in part by a donation from the Friends for Life Foundation.

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, University of Toronto Allogeneic Blood and Marrow Transplant Program, Toronto, Ontario, Canada

    Y Zaretsky, J Rifkind, R Tsang, T Kiss, W Hasegawa, G Fyles, I Tejpar, D Loach, M Minden, H Messner & J H Lipton

  2. Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada

    G Lockwood

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  1. Y Zaretsky
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  2. J Rifkind
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  3. G Lockwood
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  5. T Kiss
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Correspondence to J H Lipton.

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Zaretsky, Y., Rifkind, J., Lockwood, G. et al. Long-term follow-up of allogeneic bone marrow transplantation for patients with chronic phase chronic myeloid leukemia prepared with a regimen consisting of cyclophosphamide, cytarabine and single-dose total body irradiation conditioning. Bone Marrow Transplant 40, 423–430 (2007). https://doi.org/10.1038/sj.bmt.1705755

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