Is Drug Treatment Superior to Allografting as First-Line Therapy in Chronic Myeloid Leukaemia?  

Oleh:

Hughes, Timothy

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 35 no. 02 (Feb. 2008), page 57.
Topik: Leukaemia

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2008.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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BACKGROUND : For patient with chronic myeloid leukaemia (CML), allogenic transplantation has been considered the first line treatment option despite the fact that there had been no randomized studies comparing the treatment outcome with that seen with drug therapy. This study compared the survival times of patients who recieved allogenic transplantation for early-stage CML with those of patients who recieved drug treatment. DESIGN : Patients with CML were recuited between January 1995 and Desember 2001 and grouped according to the availability of a matched related donor. The patients with an available matched donor were then randomized to receive drug therapy or transplantation. The primary end point was survival time. RESULTS : The study included 621 patients with chronic phase CML, of whom 345 were eligible for allogeneic transplantation. This group was randomized ti recieve an allograft from a related donor (38%; n=135) or best available drug treatment (62%; n=219). Patients who recieved drug treatment had a higher rate of survival than patients who recieved allografts, both until year 8 and over the entire observation period up to year 11 (p=0.041 and p=0.049, respectively). Among patients with low-risk features at diagnosis, those allocated to drug therapy had a higher rate of survival at both 8 and 11 years'follow up than did patients who recieved transplants (p=0.027 and p=0.032, respectively), but the difference in survival was not significant. At the time of evaluation, 55% of patients in the allograft group and 60% in the drug treatment group were alive. Analyses of their health status did not identify and difference between the two group. Patients who survived >5 years were also analysed for cytogenic and molecular responses. Those who received transplantation had significantly higher rates of complete cytogenic remissions that those who did not receive transplantation (90% and 48%, respectively; p=0.002). Major molecular responses were also more frequent in patients who underwent transplantation than in those who did not (81% and 45%, respectively; p=0.001). CONCLUSION : Allogeneic transplantation should be recommended as second-line rather than first time treatment in petients with chronic phase CML.

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