Drug treatment is superior to allografting as first-line therapy in chronic myeloid leukemia

作者：Hehlmann Ruediger^*; Berger Ute; Pfirrmann Markus; Heimpel Hermann; Hochhaus Andreas; Hasford Joerg; Kolb Hans Jochem; Lahaye Tanja; Maywald Ole; Reiter Andreas; Hossfeld Dieter K; Huber Christoph; Loeffler Helmut; Pralle Hans; Queisser Wolfgang; Tobler Andreas; Nerl Christoph; Solenthaler Max; Goebeler Mariele E; Griesshammer Martin; Fischer Thomas; Kremers Stephan; Eimermacher Hartmut; Pfreundschuh Michael; Hirschmann Wolf Dietrich; Lechner Klaus; Wassmann Barbara

来源：Blood, 2007, 109(11): 4686-4692.

DOI：10.1182/blood-2006-11-055186

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 availation 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.

• 出版日期2007-6-1
• 单位河北医科大学