TY - JOUR
T1 - Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia
AU - Hehlmann, Rüdiger
AU - Berger, Ute
AU - Pfirrmann, Markus
AU - Heimpel, Hermann
AU - Hochhaus, Andreas
AU - Hasford, Joerg
AU - Kolb, Hans Jochem
AU - Lahaye, Tanja
AU - Maywald, Ole
AU - Reiter, Andreas
AU - Hossfeld, Dieter K.
AU - Huber, Christoph
AU - Löffler, Helmut
AU - Pralle, Hans
AU - Queisser, Wolfgang
AU - Tobler, Andreas
AU - Nerl, Christoph
AU - Solenthaler, Max
AU - Goebeler, Mariele E.
AU - Griesshammer, Martin
AU - Fischer, Thomas
AU - Kremers, Stephan
AU - Eimermacher, Hartmut
AU - Pfreundschuh, Michael
AU - Hirschmann, Wolf Dietrich
AU - Lechner, Klaus
AU - Wassmann, Barbara
AU - Falge, Christiane
AU - Kirchner, Hartmut H.
AU - Gratwohl, Alois
PY - 2007/6/1
Y1 - 2007/6/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=34249664406&partnerID=8YFLogxK
U2 - 10.1182/blood-2006-11-055186
DO - 10.1182/blood-2006-11-055186
M3 - Article
C2 - 17317858
AN - SCOPUS:34249664406
SN - 0006-4971
VL - 109
SP - 4686
EP - 4692
JO - Blood
JF - Blood
IS - 11
ER -