1. ¹Clinical Cooperative Group for Haematopoietic Cell Transplantation, Department of Medicine III, University of Munich, Klinikum Grosshadern and GSF- National Research Center for Environment and Health, Munich, Germany
2. ²Center for Bone Marrow Transplantation, Stiftung Deutsche Klinik fuer Diagnostik, Wiesbaden, Germany
3. ³Institut of Legal Medicine, Ludwig Maximilians University of Munich, Germany

Correspondence: Dr M Weisser, Department of Internal Medicine III, University of Munich, Klinikum Grosshadern, Marchioninistr. 15, 81377 Munich, Germany. E-mail: martin.weisser@med.uni-muenchen.de

Received 8 November 2003; Accepted 15 June 2004; Published online 18 October 2004.

Abstract

Allogeneic bone marrow or stem cell transplantation is a curative therapeutic option for chronic myelogenous leukemia. In order to decrease the toxicity of the procedure, the dosage of total body irradiation was reduced from 12 to 8 Gy and subsequently the dose of cyclophosphamide from 120 to 80 mg/kg. The purine analogue fludarabine, ATG, cyclosporine A and a short course of methotrexate were given for immune suppression. So far, 35 elderly CML patients with sibling and unrelated donors have been transplanted. Transplant-related mortality at day +100 was 11%. After engraftment, all patients achieved a complete cytogenetic remission. Relapse occurred in 14% of the patients. The risk of relapse was significantly higher in those patients transplanted in second chronic or accelerated phase (P=0.048). After a median follow-up of 30 months (range 12–62), 63% of the patients are alive. Those patients transplanted within the first year from diagnosis had an overall survival of 79% (P=0.049), emphasizing the benefit of early transplantation. Stepwise reduction of conditioning intensity resulted in stable engraftment, low relapse rates and encouraging overall survival in this high-risk patient group.