Search

Background and Objectives. To analyze the results of unrelated bone marrow transplantation (UDBMT) as treatment for chronic myeloid leukemia (CML) In,Spain, Designs and Methods. Eighty-seven consecutive UDBMT performed in 9 centers between October 1989 and February 1998 were evaluated. This represents more than 95% of UDBMT for CML performed formed in adult transplant centers in Spain during this period. The patients' median age was 31.5 years (range 12-49), The median Interval from CML. diagnosis to UDBMT was 30 months (range, 3-160). Seventy-nine percent of transplants were per formed during the first chronic phase (1CP), Results, Actuarial probability of survival and disease;free survival at 4 years for the whole series was 24% (95% confidence interval [CI]: 14%-34%) and 20% (CI: 10%-30%) respectively. The cumulative Incidence of relapse and transplant-related mortality (TRM) was 7% (CI: 4%-10%) and 71% (CI: 60%-82%), respectively. The main causes of death were graft failure (n=7), infection (n=23), and graft-versus-host disease (GVHD) (n=25), The actuarial probability of acute GVHD grade Ii-IV and grade III-IV was 56% (CI:46%-66%) and 36% (CI: 26%-36%), respectively. The cumulative Incidence of extensive chronic GvHD was 18% (CI: 9%-27%), Univariate analyses showed that the pre-transplant factor with the highest influence on survival was disease status at transplant (30% in 1CP vs. 0% in advanced phases; p=0.0001). ether pre-transplant factors influencing survival among patients in 1CP were: patient's age (older than 30 years 11% vs. 48%), interval diagnosis-transplantation (longer than 2 17% vs. 55%), donor type (HLA, a, DRB1 identical vs, 25%), CMV serologic status (donor recipient negative 63% vs. 24%), year of trans(before plantation (before 1995 19% vs. 40%), and conditioning regimen (cyclophosphamide plus total body radiation 40% vs, 16%), The main risk factors had a cumulative effect on survival. Thus, probability of survival ranged from 66% (CI: 39%-93%) In patients in 1CP, under 40 years of age, transplanted from an HLA, A, B, DRB1 identical donor during the first two years after diagnosis, to 0% in those with three or mom risk factors. Interpretation and Conclusions. This experience shows that UDBMT used to have a high TRM that has progressively decreased along the years. At the present time, the results are encouraging, particularly when UDBMT Is performed under favorable conditions (C) 2000 Ferrata Stortl Foundation.