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KMID : 0391319920020020217
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Korean Journal of Biological Response Modifiers
1992 Volume.2 No. 2 p.217 ~ p.226
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The Survival According to Various treatment Modalities for Patients with Chronic Myelogenous Leukemia: Bone Marrow Transplantation vs Interferon vs Chemotherapy
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이종욱
김동욱/진종률/한치화/민우성/박종원/김춘추/김동집
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Abstract
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Between July 1986 and December 1990, one hundred-six patients with chronic myelogenous leuke-mia (CML), 79 of whom were in chronic phase and 27in advanced state (accelerated phase, blastic crisis), were assigned to a retrospective stuty comparing
allogeneic bone marrow transplantation (BMT) with interferon (IFN), and with conventional chemotherapy. Sixty-seven patients (median age 34) received IFN α-2b (Intron-A, Shering, USA) or INF-γ(Lucky Research-Center, Korea). The IFN was given by
2×10E6 U per day subcutaneously until remission, then every other day as maintenence Twenty-three patients (median age 31) underwent allogeneic BMT from HLA-identical sibling following supralethal chemoradiotherapy. And we treated 16 patients
(median
age 34)with conventional chemotherapy including hydroxyurea, Ara-C, and VP-16.
Of IFN group, 34 patients (51%) showed complete hematologic remission (CHR), 19 (28%) partial hematologic remission (PHR), and 14(21%) failure. All patients with blastic crisis revealed failure. twenty-four patients (44%) who had reached CHR
achieved
cytogenetic remission. But except two patients, persistent bcr-abl mRNA was detected by serial cDNA-PCR analysis in peripheral mononuclear cells from patients who achieved cytogenetic remission. The median duration of continued disease control
with
IFN
therapy was 25 months for patients obtaining CHR or PHR.
After a median follow-up 35 months (range 4~80), actuarial survival at 6 years of CML patients in chronic phase treated with various treatment modalities was statistically significant (BMT 90%;IFN 29%; chemotherapy 0%; p<0.05). But the comparison
between survival of BMT group and that of IFN group did not show statistical significance (P=0.21) The comparison of survival of IFN group with that of chemotherapy group revealed statistical significance (p<0.05) The median survival in chronic
phase
has not yet been reached for BMT group, and 49 months, 36, respectively for IFN group and chemotherapy group. The actuarial survival at 3 years of OML patients in advanced state treated with BMT and IFN was 54% and 0%, respectively (P=0.09).
Our results show that the treatment modality such as BMT or IFN should be applied in the early stage of disease (in chroinc phase) to improve the survival rate in CML patients. The IFN group has at least l year survival advantage over
chemotherapy
group. Although the survival of BMT group showed better trends than that of IFN group, there was not statistically significance. Therefore these results need to be confirmed with a longer follow-up and with the further larger clinical trials
including
multicenter studies in a prospective and controlled fashion.
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KEYWORD
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