Interval From Diagnosis To Transplantation

The incidence of transplant-related mortality increases and leukemia-free survival decreases with prolongation of the interval from diagnosis to transplantation.

Figure 37.2 Effect of age on survival. There are no statistically significant differences in survival of patients aged younger than 40 years, 40 to 50 years, and older than 50 years (p = 0.55)

Although most studies have suggested a threshold at 1 or 2 years, at which point patients transplanted beyond this cutoff fare significantly worse, analysis of data from Ohio State demonstrates that interval is a continuous variable. Patients undergoing transplantation less than 3 months following diagnosis had 5 years of leukemia-free survival in excess of 90% (Figure 37.3).39 Data from Seattle indicate favorable outcomes in patients who undergo transplantation fewer than 6 months from diagnosis.40

The higher rate of transplant-related mortality associated with prolonged intervals between diagnosis and transplantation likely results from subclinical toxici-ties due to therapy. Prior busulfan41 and interferon therapy42,43 are associated with more regimen-related toxicity than hydroxyurea. The adverse influence of interferon is not seen with short-term treatment (<6 months)44 or when therapy is discontinued at least 3 months prior to transplantation.45 Preliminary results of transplantation in patients who took ima-tinib have not generally indicated an adverse influence, but data suggesting a possible adverse affect have been presented.46

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