Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia

Rüdiger Hehlmann, Ute Berger, Markus Pfirrmann, Hermann Heimpel, Andreas Hochhaus, Joerg Hasford, Hans Jochem Kolb, Tanja Lahaye, Ole Maywald, Andreas Reiter, Dieter K. Hossfeld, Christoph Huber, Helmut Löffler, Hans Pralle, Wolfgang Queisser, Andreas Tobler, Christoph Nerl, Max Solenthaler, Mariele E. Goebeler, Martin GriesshammerThomas Fischer, Stephan Kremers, Hartmut Eimermacher, Michael Pfreundschuh, Wolf Dietrich Hirschmann, Klaus Lechner, Barbara Wassmann, Christiane Falge, Hartmut H. Kirchner, Alois Gratwohl

Research output: Contribution to journalArticlepeer-review

149 Scopus citations

Abstract

Early allogeneic hematopoietic stem cell transplantation (HSCT) has been proposed as primary treatment modality for patients with chronic myeloid leukemia (CML). This concept has been challenged by transplantation mortality and improved drug therapy. In a randomized study, primary HSCT and best available drug treatment (IFN based) were compared in newly diagnosed chronic phase CML patients. Assignment to treatment strategy was by genetic randomization according to availability of a matched related donor. Evaluation followed the intention-to-treat principle. Six hundred and twenty one patients with chronic phase CML were stratified for eligibility for HSCT. Three hundred and fifty four patients (62% male; median age, 40 years; range, 11-59 years) were eligible and randomized. One hundred and thirty five patients (38%) had a matched related donor, of whom 123 (91%) received a transplant within a median of 10 months (range, 2-106 months) from diagnosis. Two hundred and nineteen patients (62%) had no related donor and received best available drug treatment. With an observation time up to 11.2 years (median, 8.9 years), survival was superior for patients with drug treatment (P = .049), superiority being most pronounced in low-risk patients (P = .032). The general recommendation of HSCT as first-line treatment option in chronic phase CML can no longer be maintained. It should be replaced by a trial with modern drug treatment first.

Original languageEnglish
Pages (from-to)4686-4692
Number of pages7
JournalBlood
Volume109
Issue number11
DOIs
StatePublished - 1 Jun 2007
Externally publishedYes

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