Changing trends in allogeneic bone marrow transplantation for leukemia in the 1980s
M. M. Bortin, M. M. Horowitz, R. P. Gale, A. J. Barrett, R. E. Champlin, K. A. Dicke, E. Gluckman, H. J. Kolb, A. M. Marmont, M. Mrsic and al. et
International Bone Marrow Transplant Registry, Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.
OBJECTIVE--To identify changes in practice and outcome of bone marrow
transplants for leukemia in the 1980s. DESIGN--Comparison of key
explanatory and outcome variables in five 2-year cohorts, from 1980 through
1981 to 1988 through 1989, using a large database of detailed clinical
information. PATIENTS--Recipients (7788) of bone marrow transplants for
acute lymphoblastic, acute myelogenous, or chronic myelogenous leukemia
reported to the International Bone Marrow Transplant Registry, Milwaukee,
Wis, by 185 transplant teams worldwide. RESULTS--Linear increases occurred
during the periods 1980 through 1981 to 1988 through 1989 as follows with
95% confidence intervals: (1) transplants for chronic myelogenous leukemia
from 14% +/- 2% to 35% +/- 2%; (2) transplants from unrelated donors from
1% +/- 1% to 7% +/- 1%; (3) preparative regimens without radiation from 3%
+/- 1% to 30% +/- 2%; and (4) use of methotrexate plus cyclosporine to
prevent graft-vs-host disease from 2% +/- 1% to 55% +/- 2%. Among
recipients of human lymphocyte antigen-identical sibling bone marrow, the
2-year probability of treatment-related mortality decreased by 6% to 22%.
The probability of relapse decreased from 46% +/- 6% to 38% +/- 6% in
intermediate leukemia but did not change appreciably in early or advanced
leukemia. Probabilities of leukemia-free survival improved from 51% +/- 4%
to 57% +/- 3% in early leukemia, from 28% +/- 4% to 36% +/- 5% in
intermediate leukemia, and from 12% +/- 4% to 18% +/- 5% in advanced
leukemia. A separate analysis of a homogenous population of patients
indicated that improvements in outcome in the 1980s were due to
improvements in transplant practice rather than improved patient selection.
CONCLUSIONS--Modest increases in leukemia-free survival rates occurred
after human lymphocyte antigen-identical sibling bone marrow transplants in
the 1980s. Improvements were due primarily to reductions in
treatment-related mortality with little or no change in relapse risk. More
effective antileukemia strategies and continued reductions in
treatment-related toxic effects are needed.
Improvements in survival of adults diagnosed with acute myeloblastic leukemia in the early 21st century
Pulte et al.
haematol 2008;93:594-600.
ABSTRACT
| FULL TEXT
Reprogramming Immune Responses: Enabling Cellular Therapies and Regenerative Medicine
Down and White-Scharf
Stem Cells 2003;21:21-32.
ABSTRACT
| FULL TEXT
Nonmyeloablative transplantation with or without alemtuzumab: comparison between 2 prospective studies in patients with lymphoproliferative disorders
Perez-Simon et al.
Blood 2002;100:3121-3127.
ABSTRACT
| FULL TEXT
Melphalan and purine analog-containing preparative regimens: reduced-intensity conditioning for patients with hematologic malignancies undergoing allogeneic progenitor cell transplantation
Giralt et al.
Blood 2001;97:631-637.
ABSTRACT
| FULL TEXT
Malignant Neoplasms in Long-Term Survivors of Bone Marrow Transplantation
Kolb et al.
ANN INTERN MED 1999;131:738-744.
ABSTRACT
| FULL TEXT
Minimal Residual Disease Status Before Allogeneic Bone Marrow Transplantation Is an Important Determinant of Successful Outcome for Children and Adolescents With Acute Lymphoblastic Leukemia
Knechtli et al.
Blood 1998;92:4072-4079.
ABSTRACT
| FULL TEXT
Effect of Matching of Class I HLA Alleles on Clinical Outcome after Transplantation of Hematopoietic Stem Cells from an Unrelated Donor
Sasazuki et al.
NEJM 1998;339:1177-1185.
ABSTRACT
| FULL TEXT
Engraftment of Allogeneic Hematopoietic Progenitor Cells With Purine Analog-Containing Chemotherapy: Harnessing Graft-Versus-Leukemia Without Myeloablative Therapy
Giralt et al.
Blood 1997;89:4531-4536.
ABSTRACT
| FULL TEXT
