Nonmyeloablative Peripheral Blood Stem Cell Transplantation for Chronic Myeloid Leukemia in Chronic and Advanced Phases.

Abstract

Objective: To study the effect of nonmyeloablative peripheral blood stem cell transplantation(PBSCT) for chronic myelogenous leukemia(CML) in chronic phase(CML-CP) and advanced phase(CML-AP).Methods: Twenty-four CML patients, 16 in CML-CP and 4 in CML-AP underwent nonmyeloablative peripheral blood stem cell transplantation(NST). The conditioning regimen included fludarabine 30mg.m−2.d−1, intravenously(i.v.)×6d, busulphan 4mg.m−2.d−1×2d and CTX 350mg.m−2.d−1×2d combined with or without Ara-C. The donors were HLA-identical (n=20) and 5/6 antigen-matched (n=4).Results: All the patients were successfully engrafted. The mean time needed for increase of the number of neutrophils to more than 0.5×109/L and platelet more than 20×109/L were 13 days and 11.5 days respectively. Among 12 patients, 9 showed complete donor chimerism(CDC) and 3 showed mixed chimerism(MC) at +day 30. At +day 180, 18 patients still alive showed CDC and remained alive after a median follow-up of 24 months (4∼48months). 3 cases died of severe acute GVHD(aGVHD), 1 case of chronic GVHD(cGVHD), 2 cases of interstitial pneumonia(IP) and 1 case of relapse.Conclusion: Nonmyeloablative PBSCT is an effective method for CML patients in chronic phase and advanced phase.Characteristics of 24 CML patients and their donorsPatientAgeGenderDiagnosisDonorHLA140maleCML-APbrotherHLA-identical232maleCML-APbrotherHLA-identical340maleCML-CPbrotherHLA-identical440maleCML-CPbrotherHLA-identical542maleCML-APbrotherHLA-identical624maleCML-APsisterHLA-identical755maleCML-CPsisterHLA-identical832maleCML-CPbrotherHLA-identical936maleCML-CPbrotherHLA-identical1046femaleCML-APsisterHLA-identical1152femaleCML-CPbrotherHLA-identical1260maleCML-CPsisterHLA-identical1345femaleCML-CPbrotherHLA-identical1448maleCML-CPbrotherHLA-identical1533maleCML-CPURD*HLA-identical1635femaleCML-CPURDHLA-identical1740maleCML-CPbrotherHLA-identical1834femaleCML-APsisterHLA-identical twin1954femaleCML-CPbrotherHLA-identical2033maleCML-APURDSubtype mismatched2132maleCML-CPURDSubtype mismatched2242maleCML-CPURDmismatched2350femaleCML-CPURDHLA-identical2446maleCML-CPbrotherHLA-identical*: unrelated donor