RT-PCR studies in patients with chronic myeloid leukemia (CML) in remission 5 years after allogeneic stem cell transplant (SCT) define risk of subsequent relapse

T. I. Mughal, A. Yong, R. M. Szydlo, J. Kaeda, N. C.P. Cross, C. Craddock, E. Kanfer, J. F. Apperley, J. M. Goldman

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Abstract

103 consecutive patients in molecular remission 5 years after allogeneic SCT for CML with either HLA-identical sibling donors (n=71 ) or phenotypically HLA-matched unrelated donors (n=32) were identified. The study cohort was defined on the basis of survival with a negative RT-PCR for BCR-ABL transcripts in peripheral blood within 3 months of the 5 year landmark. The patients were classified into three groups: group A comprised 64 patients who had been continuously PCR negative post-transplant, group B 19 patients who had had one or more positive PCR study and group C 20 patients who had relapsed and had then regained complete molecular remission following treatment with donor lymphocyte infusion (DLI) within the initial 5 year period. All patients were monitored at regular intervals after the 5 year landmark. The median period of follow-up for all 103 patients was 8.4 yrs post-SCT (range 5-17.6 yrs). Of patients in group A. only one patient satisfied criteria for molecular relapse at 9.5 years and the actuarial survival at 10 years was 100%. 7 patients (37%) in group B satisfied molecular criteria for relapse and one of these proceeded to cytogenetic relapse. The actuarial survival at 10 years for group B patients was 90% and for group C patients was 100%. The probability of relapse at 10 years in group B patients was 54%. We conclude that molecular studies during the first 10 years post-transplant help to predict long-term leukemia-free survival and possibly cure of CML. Patients who show transient evidence of relapse at the molecular level within 5 years of SCT may be at a risk for subsequent sustained relapse. It is noteworthy that the significant minority who do relapse at a molecular level can be successfully restored to a molecular remission following treatment with DLI.

Original languageEnglish
Pages (from-to)141a
JournalBlood
Volume96
Issue number11 PART I
Publication statusPublished - 1 Dec 2000

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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