What are the mortality rates for chronic myelogenous leukemia (CML) following allogeneic BMT?

Updated: May 23, 2021
  • Author: Emmanuel C Besa, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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Answer

The mortality rate associated with BMT is 10-20% or less with a matched sibling and 30-40% with an unrelated donor. The bone marrow registry approximates the cure rate for patients with CML at 50%.

Transplantation has been relegated to patients who do not achieve molecular remissions or show resistance to imatinib and failure of second-generation bcr-abl kinase inhibitors such as dasatinib. Previous exposure to imatinib before transplantation does not adversely affect posttransplant outcomes such as overall survival and progression-free survival.

A retrospective analysis that included 70 patients with CML (44% in accelerated phase or blast crisis) who had received imatinib before stem cell transplantation showed 90% engraftment and estimated transplant-related mortality of 44% and estimated relapse mortality of 24% at 24 months. Graft versus host disease rates were 42% for acute and 17% for chronic. [63]

Most data are from allogeneic transplantations from HLA-matched sibling donors and a few syngeneic transplantations from an identical twin. Data show that allogeneic transplantations have better results than syngeneic transplantations because of some graft versus leukemia effects.

Autologous BMT is investigational, but, relatively recently, chemotherapy combinations or interferon have been found to induce a cytogenetic remission and allow harvesting of Ph-negative CD34 hematopoietic stem cells from the patient's peripheral blood.

The advent of imatinib therapy has overshadowed allogeneic hematopoietic stem cell transplantation in newly diagnosed CML. However, it has been suggested that patients with a poor-risk Sokal score (see Prognosis) but good risk for allogeneic hematopoietic stem cell transplantation be transplanted early or upfront. No current consensus exists on these issues. However, a widely accepted consensus is that patients who progress beyond chronic phase on imatinib should be offered hematopoietic stem cell transplantation if this is an option.

With patients in blast crisis who are imatinib naive, the drug is used in combination with induction regimens similar to those used in acute myelogenous or lymphoblastic leukemia. However, because a high percentage of imatinib-resistant mutations exist in these patients, relapses occur more frequently and at an earlier time from induction. Thus, all efforts are made to perform an allogeneic hematopoietic stem cell transplantation as soon as possible.

Most patients with minimal residual disease (MRD) after transplantation require interferon maintenance therapy. Alternatively, they may require a reinfusion of T cells collected from the donor (ie, donor lymphocyte infusion).


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