Blood Journal
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Allogeneic hematopoietic stem cell transplantation (allo SCT) for chronic myeloid leukemia in the imatinib era: evaluation of its impact within a subgroup of the randomized German CML Study IV

  1. Susanne Saussele1,
  2. Michael Lauseker2,
  3. Alois Gratwohl3,
  4. Dietrich W. Beelen4,
  5. Donald Bunjes5,
  6. Rainer Schwerdtfeger6,
  7. Hans-Jochem Kolb7,
  8. Anthony D. Ho8,
  9. Christiane Falge9,
  10. Ernst Holler10,
  11. Günter Schlimok11,
  12. Axel R. Zander12,
  13. Renate Arnold13,
  14. Lothar Kanz14,
  15. Robert Dengler15,
  16. Claudia Haferlach16,
  17. Brigitte Schlegelberger17,
  18. Markus Pfirrmann2,
  19. Martin C. Müller1,
  20. Susanne Schnittger16,
  21. Armin Leitner1,
  22. Nadine Pletsch1,
  23. Andreas Hochhaus1,18,
  24. Joerg Hasford2,
  25. Rüdiger Hehlmann1, and
  26. for the German CML Study Group
  1. 1III Medizinische Klinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany;
  2. 2Institut für Medizinische Informationsverarbeitung (IBE), Universität München, Germany;
  3. 3Hämatologie, Universitätsspital Basel, Basel, Switzerland;
  4. 4Klinik für Knochenmarktransplantation, Universitätsklinikum der Universität Duisburg-Essen, Duisburg-Essen, Germany;
  5. 5Klinik für Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany;
  6. 6Zentrum für Knochenmarktransplantation, Deutsche Klinik für Diagnostik (DKD), Wiesbaden, Germany;
  7. 7Medizinische Klinik III, Klinikum Großhadern, Universität München, München, Germany;
  8. 8Medizinische Klinik V, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany;
  9. 9Klinikum Nord, Nürnberg, Germany;
  10. 10Universitätsklinikum Regensburg, Regensburg, Germany;
  11. 11II Medizinische Klinik, Zentralklinikum Augsburg, Germany;
  12. 12Zentrum für Knochenmarktransplantation (KMT), Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Germany;
  13. 13Charité Universitätsmedizin Berlin, Berlin, Germany;
  14. 14Innere Medizin II, Universitätsklinikum Tübingen, Tübingen, Germany;
  15. 15Hämatologisch-onkologische Praxis, Regensburg, Germany;
  16. 16MLL Munich Leukemia Laboratory, Munich, Germany;
  17. 17Institut für Zell-und Molekularpathologie, Medizinische Hochschule Hannover (MHH), Hannover, Germany; and
  18. 18Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany

Abstract

The role of allogeneic stem cell transplantation in chronic myeloid leukemia is being reevaluated. Whereas drug treatment has been shown to be superior in first-line treatment, data on allogeneic hematopoietic stem cell transplantation (allo SCT) as second-line therapy after imatinib failure are scarce. Using an interim safety analysis of the randomized German CML Study IV designed to optimize imatinib therapy by combination, dose escalation, and transplantation, we here report on 84 patients who underwent consecutive transplantation according to predefined criteria (low European Group for Blood and Marrow Transplantation [EBMT] score, imatinib failure, and advanced disease). Three-year survival after transplantation of 56 patients in chronic phase was 91% (median follow-up: 30 months). Transplantation-related mortality was 8%. In a matched pair comparison of patients who received a transplant and those who did not, survival was not different. Three-year survival after transplantation of 28 patients in advanced phase was 59%. Eighty-eight percent of patients who received a transplant achieved complete molecular remissions. We conclude that allo SCT could become the preferred second-line option after imatinib failure for suitable patients with a donor. The study is registered at the National Institutes of Health, http://clinicaltrials.gov: NCT00055874.

  • Submitted August 12, 2009.
  • Accepted October 22, 2009.
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