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Bone Marrow Transplantation for Chronic Myelogenous Leukemia in Chronic Phase: Increased Risk for Relapse Associated with T-Cell Depletion

JOHN M. GOLDMAN, M.D.; ROBERT PETER GALE, M.D., Ph.D.; MARY M. HOROWITZ, M.D.; JAMES C. BIGGS, M.D., Ph.D.; RICHARD E. CHAMPLIN, M.D.; ELIANE GLUCKMAN, M.D.; RAYMOND G. HOFFMANN, Ph.D.; STEVEN J. JACOBSEN; ALBERTO M. MARMONT, M.D.; PHILIP B. McGLAVE, M.D.; HANS A. MESSNER, M.D., Ph.D.; ALFRED A. RIMM, Ph.D.; CIRIL ROZMAN, M.D.; BRUNO SPECK, M.D.; SANTE TURA, M.D.; ROY S. WEINER, M.D.; and MORTIMER M. BORTIN, M.D.
[+] Article and Author Information

This 40th report from the International Bone Marrow Transplant Registry was prepared for the Advisory Committee: R. P. Gale, Los Angeles (Chairman); F.H. Bach, Minneapolis; A.J. Barrett, London; D.W. van Bekkum, Rijswijk; J.C. Biggs, Sydney; K.G. Blume, Duarte; M.M. Bortin, Milwaukee; K.A. Dicke, Houston; E. Gluckman, Paris; J.M. Goldman, London; R.A. Good, St. Petersburg; R.H. Herzig, Cleveland; R. Hong, Madison; J.H. Kersey, Minneapolis; H-J KoIb, Munich; A.M. Marmont, Genoa; T. Masaoka, Osaka; H.A. Messner, Toronto; R.J. O'Reilly, New York; R.L. Powles, London; A.A. Rimm, Milwaukee; O. Ringden, Huddinge; J.J. van Rood, Leiden; C. Rozman, Barcelona; B. Speck, Basel; R.S. Weiner, Gainesville; and F.E. Zwaan, Leiden.

Institutions contributing patient data for this report were Australia: Alfred Hospital, Prahran; Prince of Wales Children's Hospital, Randwick; St. Vincent's Hospital, Sydney; Queen Elizabeth Hospital, Woodville. Austria: Med. Univ.-Klinik, Vienna. Belgium: Cliniques Universitaires Saint-Luc, Bruxelles; Academisch Ziekenhuis St. Raphael, Leuven. Brazil: Hospital de Clinicas, Parana. Canada: Tom Baker Cancer Center, Calgary; McMaster University, Hamilton; Ontario Cancer Institute, Toronto. China: Beijing Medical Center, Beijing. Denmark: Rigshospitalet, Copenhagen. England: Queen Elizabeth Hospital, Birmingham; St. James's Hospital, Leeds; Hammersmith Hospital, London; London Clinic, London; Royal Free Hospital, London; Royal Marsden Hospital, London; Westminster Hospital, London; Royal Victoria Infirmary, Newcastle. Finland: University of Helsinki, Helsinki. France: Universitaire D'Angers, Angers; Centre Regional de Transfusion Sanguine, Besancon; Centre Hospitalier et Universitaire, Bordeaux; Hôpital des Sablons, Grenoble; Hôpital Debrousse, Lyon; Institut J. Paoli I. Calmettes, Marseille; Centre Hospitalier Regional, Nancy; Hôpital Saint Louis, Paris. East Germany: Karl Marx Universität, Leipzig. West Germany: Christian Albrechts Universität, Kiel; Universitäts-Kinderklinik, Munich; Universität Ulm, Ulm/Donau. Hungary: Semmelweis University, Budapest. India: Tata Memorial Hospital, Bombay. Ireland: St. James's Hospital, Dublin. Italy: S. Orsola University Hospital, Bologna; Ospedale San Martino, Genoa; University of Milan, Milan; Ospedale Riuniti di Pesaro, Pesaro; Universita-Chieti, Pescara; Universita degli Studi La Sapienza, Rome. Japan: Tokai University, Isahara; Kanazawa University, Kanazawashi; Daini Red Cross Hospital, Nagoya; Center for Adult Diseases, Osaka. The Netherlands: University Hospital Leiden, Pediatrics, Leiden; Katholieke Universiteit, Nijmegen; Dr. Daniel Den Hoed Cancer Center, Rotterdam. Saudi Arabia: King Faisal Hospital, Riyadh. Scotland: Royal Infirmary, Edinburgh; Glasgow Royal Infirmary, Glasgow. South Africa: University of Cape Town Medical School, Cape Town. Spain: University of Barcelona, Barcelona; Clinica Puerta de Hierro, Madrid; Hospital de la Princesa, Madrid; Centro Medico Nacional "Marques de Valdecilla," Santander; Cuidad Sanitaria, Valencia. Sweden: Huddinge Hospital, Huddinge. Switzerland: Kantonsspital Basel, Basel; Kantonsspital Zurich, Zurich. Taiwan: National Taiwan University Hospital, Taipei. USA: Emory University School of Medicine, Atlanta; Alta Bates Hospital, Berkeley; University of Alabama, Birmingham; Case Western Reserve University Hospitals, Cleveland; City of Hope National Medical Center, Duarte; University of Florida, Gainesville; Children's Hospital, Houston; M. D. Anderson Hospital, Houston; Texas Medical Center, Houston; University of Kansas, Kansas City; UCLA-Center for Health Sciences, Los Angeles; Loyola University Medical Center, Maywood; Medical College of Wisconsin, Milwaukee; University of Minnesota, Minneapolis; Bishop Clarkson Memorial Hospital, Omaha; University of Nebraska, Omaha; Oklahoma Teaching Hospitals, Oklahoma City; Hahnemann University, Philadelphia. Yugoslavia: Klinka Unutrasnje bolesti-KBC-Rebro, Zagreb.

Grant support: in part by Public Health Service grant CA 40053 from the National Cancer Institute, Department of Health and Human Services; Public Health Service contract N01-AI-62530 from the National Institute of Allergy and Infectious Diseases, Department of Health and Human Services; contract B16-0084-US from the Commission of the European Communities; grants from the William Randolph Hearst Foundation; Ambrose Monell Foundation; Elsa U. Pardee Foundation; Proctor & Gamble Co.; RGK Foundation; Sandoz Research Institute; the Swiss Cancer League; and Xoma Corporation.

▸Requests for reprints should be addressed to Mary M. Horowitz, M.D.; International Bone Marrow Transplant Registry, Medical College of Wisconsin, P.O. Box 26509; Milwaukee, WI 53226.


Milwaukee, Wisconsin; London, United Kingdom; Los Angeles, California; Darlinghurst, Australia; Paris, France; Genoa and Bologna, Italy; Minneapolis, Minnesota; Toronto, Ontario; Barcelona, Spain; Basel, Switzerland; and Gainesville, Florida


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(6):806-814. doi:10.7326/0003-4819-108-6-806
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Data on 405 patients with chronic myelogenous leukemia who received bone marrow transplants in chronic phase were analyzed for factors predictive of outcome. The 4-year actuarial probability of relapse was 19% (95% confidence interval [Cl], 12% to 28% ) and of survival, 55% (95% Cl, 50% to 60%). In multivariate analyses the probability of relapse was higher for recipients of T-cell-depleted bone marrow compared with recipients of non-T-cell-depleted bone marrow (relative risk, 5.4; P < 0.0001) and for patients who did not develop chronic graft-versus-host disease with patients who did (relative risk, 3.1; P < 0.01). The probability of survival was lower for patients who developed moderate to severe acute graft-versus-host disease than for patients with no or mild acute graft-versus-host disease (relative risk, 3.7; P < 0.0001), and in patients aged 20 or older than in younger patients (relative risk, 2.6; P < 0.0002). Duration of disease before transplant was not associated with outcome. Bone marrow transplantation done in the chronic phase of chronic myelogenous leukemia offers some patients prolonged leukemia-free survival. The Tcell-depleted grafts are associated with an increased probability of relapse.

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