Document Detail

Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia.
MedLine Citation:
PMID:  17317858     Owner:  NLM     Status:  MEDLINE    
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.
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 Griesshammer; Thomas Fischer; Stephan Kremers; Hartmut Eimermacher; Michael Pfreundschuh; Wolf-Dietrich Hirschmann; Klaus Lechner; Barbara Wassmann; Christiane Falge; Hartmut H Kirchner; Alois Gratwohl
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-02-22
Journal Detail:
Title:  Blood     Volume:  109     ISSN:  0006-4971     ISO Abbreviation:  Blood     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-24     Completed Date:  2007-07-02     Revised Date:  2008-02-26    
Medline Journal Info:
Nlm Unique ID:  7603509     Medline TA:  Blood     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4686-92     Citation Subset:  AIM; IM    
III Medizinische Universitätsklinik, Medizinische Fakultät Mannheim der Universität Heidelberg, Wiesbadener Strasse 7-11, 63805 Mannheim, Germany.
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MeSH Terms
Antineoplastic Agents / pharmacology*
Cohort Studies
Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy*,  therapy*
Middle Aged
Transplantation, Homologous / methods*
Treatment Outcome
Reg. No./Substance:
0/Antineoplastic Agents
Comment In:
Nat Clin Pract Oncol. 2008 Jan;5(1):14-5   [PMID:  17940526 ]
Blood. 2007 Dec 15;110(13):4618; author reply 4618-9   [PMID:  18056847 ]

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