Evaluating survival after allogeneic bone marrow transplant for chronic myeloid leukaemia in chronic phase: a comparison of transplant versus no transplant in cohort of 258 patients first seen in Italy between 1984 and 1986.

Information on the outcome of allogeneic bone marrow transplant (BMT) for chronic myeloid leukaemia (CML) was previously provided by BMT centres or registries. This report uses the data from another source, based on a cohort of 258 patients aged 50 or less who were first seen and recruited between 1984 and 1986 at 55 Italian hospitals. These patients were registered and followed for a prospective study of the course and prognosis of CML, without any obligations for treatment. All patients had Ph + CML; 50 of them were transplanted in first chronic phase (CP), and 208 were not transplanted. Leukaemia-free survival at 8 years was 34% (95% CI 20-47%) for the transplant group versus zero in the non-transplant group. Overall survival at 8 years was 43% (95% CI 29-57%) for the transplant group versus 25% (95% CI 19-32%) in the non-transplant group (P = 0.24). The difference in overall survival between transplant and non-transplant was significant in patients less than 30 years old (P = 0.035), but not in patients aged 30-50 years (P = 0.439). This report points out that although freedom from leukaemia could be obtained only with BMT, a beneficial effect of BMT on overall survival could be detected only in a patients' subset, and that many hundreds of cases and a decade could be necessary to evaluate the effect on survival of new transplant policies.