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August 5, 1992

Changing Trends in Allogeneic Bone Marrow Transplantation for Leukemia in the 1980s

Author Affiliations

From the International Bone Marrow Transplant Registry, Department of Medicine (Dr Bortin), and the Divisions of Cancer and Blood Diseases (Dr Horowitz) and Biostatistics/Clinical Epidemiology (Ms Sobocinski and Dr Rimm), Medical College of Wisconsin, Milwaukee; the UCLA Center for the Health Sciences, Los Angeles, Calif (Dr Gale); the Royal Postgraduate Medical School, London, England (Dr Barrett); the M. D. Anderson Cancer Center, Houston, Tex (Dr Champlin); the Center for Cancer Prevention and Treatment, Houston, Tex (Dr Dicke); the Hôpital St Louis, Paris, France (Dr Gluckman); the Universität München, Munich, Germany (Dr Kolb); the Ospedale San Martino, Genoa, Italy (Dr Marmont); the University of Croatia, Zagreb (Dr Mrsic); and the University of Florida, Gainesville (Dr Weiner).

JAMA. 1992;268(5):607-612. doi:10.1001/jama.1992.03490050055025

Objective.  —To identify changes in practice and outcome of bone marrow transplants for leukemia in the 1980s.

Design.  —Comparison of key explanatory and outcome variables in five 2-year cohorts, from 1980 through 1981 to 1988 through 1989, using a large database of detailed clinical information.

Patients.  —Recipients (7788) of bone marrow transplants for acute lymphoblastic, acute myelogenous, or chronic myelogenous leukemia reported to the International Bone Marrow Transplant Registry, Milwaukee, Wis, by 185 transplant teams worldwide.

Results.  —Linear increases occurred during the periods 1980 through 1981 to 1988 through 1989 as follows with 95% confidence intervals: (1) transplants for chronic myelogenous leukemia from 14%±2% to 35%±2%; (2) transplants from unrelated donors from 1%±1% to 7%±1%; (3) preparative regimens without radiation from 3%±1% to 30%±2%; and (4) use of methotrexate plus cyclosporine to prevent graft-vs-host disease from 2%±1% to 55%±2%. Among recipients of human lymphocyte antigen—identical sibling bone marrow, the 2-year probability of treatment-related mortality decreased by 6% to 22%. The probability of relapse decreased from 46%±6% to 38%±6% in intermediate leukemia but did not change appreciably in early or advanced leukemia. Probabilities of leukemia-free survival improved from 51%±4% to 57%±3% in early leukemia, from 28%±4% to 36%±5% in intermediate leukemia, and from 12%±4% to 18%±5% in advanced leukemia. A separate analysis of a homogenous population of patients indicated that improvements in outcome in the 1980s were due to improvements in transplant practice rather than improved patient selection.

Conclusions.  —Modest increases in leukemia-free survival rates occurred after human lymphocyte antigen—identical sibling bone marrow transplants in the 1980s. Improvements were due primarily to reductions in treatment-related mortality with little or no change in relapse risk. More effective antileukemia strategies and continued reductions in treatment-related toxic effects are needed.(JAMA. 1992;268:607-612)