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Chronic Myelogenous Leukemia (CML) Outcomes

The survival graphs below illustrate outcomes of unrelated donor hematopoietic cell transplants (bone marrow, PBSC, or cord blood transplants — BMT) facilitated by the National Marrow Donor Program® (NMDP) for adult patients.

Five-year survival for adult patients (≥18 years of age) transplanted for chronic myelogenous leukemia (CML) using marrow (Figure 1) or peripheral blood stem cells (PBSC) (Figure 2) is significantly increased in patients transplanted in first chronic phase compared to those patients transplanted in accelerated or second chronic phase or those in blastic phase.

Both PBSC and cord blood are being studied under FDA investigational new drug (IND) protocols. Researchers continue to investigate rates of graft-versus-host disease (GVHD) and other characteristics of both stem cell sources.

In one such study, the NMDP and the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) conducted a large-scale, multi-center phase III clinical trial to determine if graft source (PBSC or marrow) affects transplant outcomes in unrelated donor transplantation for CML and other hematologic malignancies. [1]

The study found that PBSC and bone marrow transplant recipients had comparable two-year survival: 51% vs. 46%, respectively (p=0.29). However, chronic GVHD developed more often and was more severe in patients who received PBSC compared with those receiving marrow. [2]

Figure 1.
Chronic myelogenous leukemia: Survival of adult marrow transplant patients 2000-2009. (NMDP data)
CML: Survival of adult marrow transplant patients 2000-2009
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Figure 2.
Chronic myelogenous leukemia: Survival of adult PBSC transplant patients 2000-2009. (NMDP data)
CML: Survival of adult PBSC transplant patients 2000-2009
View larger version    Download slide (PPT)  

 

References

  1. BMT CTN Protocol 0201 - A Phase III randomized multicenter trial comparing G-CSF mobilized peripheral blood stem cell with marrow transplantation from HLA compatible unrelated donors.
    https://web.emmes.com/study/bmt2/protocol/0201__protocol/
    0201_protocol.html      
  2. Anasetti C, Logan BR, Lee SJ, et al. Peripheral-blood stem cells versus bone marrow from unrelated donors. N Engl J Med. 2012; 367(16): 1487-1496.
    http://www.nejm.org/doi/full/10.1056/NEJMoa1203517