Intensive treatment in order to minimize the Ph-positive clone in chronic myelogenic leukemia

Autor: Ann-Mari Udén, Claes Malm, Bengt Simonsson, Robert Hast, Anders Wahlin, Gösta Gahrton, Gunnar Öberg, Jan Westin, Mats Björeman, Andreas Killander, Eva Löfvenberg, Jan Carneskog, Ingemar Turesson, Lars Vilén, Magnus Björkholm
Rok vydání: 1992
Předmět:
Zdroj: Leukemialymphoma.
ISSN: 1042-8194
Popis: Several studies indicate that interferon (IFN) treatment, intensive chemotherapy and autologous bone marrow transplantation (ABMT) effectively reduce the Ph-positive clone in Chronic Myelogenic Leukemia (CML). In the present study on patients ≤ 55 years, we have combined these three treatment modalities. The aim of the study was to eliminate or minimize the Ph-positive clone to see whether a status of minimal residual or Ph-negative disease could be maintained for a longer period of time. After diagnosis, patients received interferon (IFN-a-2b) and hydroxyurea (HU) to keep the white blood cell (WBC) and platelet count below 2–4 and 100–150 × 109/1, respectively. After six months of treatment, Ph-analysis was performed. Patients with Ph-positive cells in bone marrow then received 1–3 courses of intensive chemotherapy. In patients Ph-negative after two courses, bone marrow was harvested and used for ABMT. After a third course, patients with up to 50% Ph-positive metaphases were accepted for ABMT. As of January 1, 1993, 97 patients were registered in the study. Six months of IFN+HU reduced the percentage of Ph-positive metaphases in 57% of the patients (7% became Ph-negative). The corresponding figures after two intensive cytotherapies were 70% (40% Ph-negative). Eighteen patients were autotransplanted. Seven have relapsed with Ph-positivity 3–22 months after ABMT, while nine are Ph-negative at 1–32+ months after ABMT (two not yet analyzed). Seventeen patients are alive and well, while one died one month after ABMT due to interstitial pneumonia. Of the remaining 79 patients, 32 are in continuous chronic phase, 34 were allotransplanted and 13 have died (three during Daunorubicin Ara-C [DA]) treatment, one refusing transfusions, nine in blastic transformation). We conclude that intensive treatment effectively reduces the Ph-positive clone in CML. Bone marrow can remain Ph-negative for 32+ months after ABMT. A long follow-up is needed to see whether this treatment prolongs time to metamorphosis.
Databáze: OpenAIRE