Imatinib has profoundly change indication of allogeneic bone marrow transplantation (alloBMT) worldwide for CML and is now the first line of treatment in most countries. However, in Brazil, Imatinib for CML in first chronic phase is provided by Federal Health Agency only for patients refractory/intolerant to interferon (IFN). In order to study results of treatment with imatinib and alloBMT in this particular scenario we retrospectively analyzed 266 patients treated for CML in first chronic phase (less than 60 years-old) in three different institutions in Brazil. End points were event free survival (EFS = absence of hematological response, lost of hematological/cytogenetic response, relapse in accelerated phase/blast crisis or death) and overall survival (OS). From jan/2001 to dec/2006, 176 patients received imatinib 400 mg after failure or intolerance to IFN. Median time from diagnosis to imatinib treatment was 19 months (range: 2 to 205). At the same period of time, 90 patients received an allo-BMT from an HLA-matched sibling (n=83) or an unrelated donor (n=7). Patients receiving peripheral blood stem cell or umbilical cord blood were excluded. Eighty-two patients received busulfan+cyclophsphamide as conditioning regimen and all patients received cyclosporin+methotrexate±steroids as GVHD prophylaxis. Median time from diagnosis to allo-BMT was 16 (range: 5 to 104) months. Gender distribution was similar between groups. Imatinib group had a higher median age (40.7 vs. 32.8 years, P<0.001). With a median follow up of 3 years, 5-year estimate EFS was 67.6% for patients receiving imatinib and 51.8% for patients receiving an allo-BMT (P=0.0002). Estimate overall survival at 5 years was 92.7% for patients treated with imatinib and 58.8% for patients receiving an allo-BMT (P<0.0001). Allo-BMT should be no more recommended as a first line alternative treatment, even if imatinib is available only for patients refractory/intolerant to IFN. Impressively, OS in Imatinib group were quite similar to those seen at the imatinib arm of IRIS study (

Druker BJ et al.
N Engl J Med
2006
;
355
:
2408
).

Topics:
bone marrow transplantation, allogeneic, imatinib mesylate, leukemia, myelocytic, chronic, accelerated phase, blast phase, follow-up, graft-versus-host disease, human leukocyte antigens, human leukocyte interferon, interferons

Author notes

Disclosure: No relevant conflicts of interest to declare.

2007, The American Society of Hematology
2007
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