Bone Marrow Transplantation for Chronic Myeloid Leukemia in France. Results of the French Cooperative Group

Transplants were performed in 281 patients (pts) with chronic myeloid leukemia (CML) in France between 1979 and 1986. The actuarial survival after 5 years is 55% for the patients receiving grafts in first chronic phase (CP), 43% for the patients given grafts in accelerated phase (AP) or second CP, and 35% for the patients receiving grafts in blastic crisis (BC). The main cause of death was interstitial pneumonitis and/or acute graft-versus-host disease (AGVHD). The incidence of AGVHD appears correlated with prophylactic treatment: 58% after methotrexate alone (MTX), 41% after cyclosporine (CSA), 26% after MTX + CSA, and only 14% after T-cell depletion. On the contrary, the relapse rate was much higher after T-cell depletion or syngeneic bone marrow transplantation (BMT) (70%) than after allogeneic non-T-cell-depleted BMT (18%). In this last group of patients, the relapse rate is correlated with the phase of CML at time of BMT: 10% for 102 patients in first CP and 30% for 77 patients in more advanced disease. Finally, the incidence of long-term disease-free survival is 55% for patients receiving grafts in first CP with a non-T-cell-depleted marrow. We conclude that the probability of cure after allogeneic BMT is very high, especially for patients in CP receiving non-T-cell-depleted marrow.