Bone marrow transplantation for treatment of chronic myelogenous leukaemia (CML)--preliminary experience in Singapore.
Chronic Myelogenous Leukaemia (CML) is a clonogeneic disease with the Philadelphia (Ph') chromosome as a cytogenetic marker. Conventional therapy rarely leads to cure in CML. Treatment of CML by bone marrow transplantation (BMT) is thus a reasonable alternative. This study reports on nine patients in chronic phase CML who were given allogeneic bone marrow transplantation with bone marrow cells from HLA identical siblings. There were 5 males and 4 females. Median age was 25 years (range 15-33 years). Median time from diagnosis to BMT was 8 months (range 25 to 48 months). Conditioning regimens: (i) 4 patients received cyclophosphamide 60 mgm/kg x 2 days and Total Body Irradiation (TBI) 200 rads x 6 doses x 3 days. (ii) 5 patients received busulphan 4 mgm/kg per day x 4 days followed by cyclophosphamide 60 mgm/kg x 2 days. Cyclosporin A (CSA) and methotrexate (MTX) was administered for Graft-Versus-Host-Disease (GVHD) prophylaxis in 8 patients; one patient received CSA and prednisolone. Median time for engraftment and for peripheral blood granulocytes to reach more than 500/ul was 18 days (range 12-30 days). Median time for platelet count to reach more than 20,000/ul was 25.5 days (range 15-30 days). 33% of patients developed acute GVHD of Grade II and above. The acturial survival of the 9 patients is 46%. Eight of 9 patients transplanted had two or more risk factors which adversely affect prognosis in CML. Four patients are alive and in remission at 562, 386, 46 and 46 days post-BMT respectively.
