BACKGROUND: Chronic myelogenous leukemia (CML) is an indolent but ultimately fatal disease. Because the natural history of CML varies and quality of life with CML may be excellent until shortly before death, deciding whether and when to pursue unrelated donor bone marrow transplantation is often difficult. OBJECTIVE: To compare early transplantation, delayed transplantation, and no transplantation for patients with chronic-phase CML on the basis of discounted, quality-adjusted life expectancy. DESIGN: A markov model comparing different strategies was constructed. This model considers patient age, quality of life, risk aversion, and the competing risks for CML progression and transplant toxicity. SETTING: Therapeutic decision at the time of diagnosis of CML. PATIENTS: The base case is a 35-year-old patient with intermediate-prognosis CML. Younger and older patients with better and worse prognoses are also evaluated. INTERVENTION: Early transplantation, delayed transplantation, and no transplantation. MEASUREMENTS: Quality-adjusted, discounted life expectancy. RESULTS: For patients with newly diagnosed CML, transplantation within the first year provides the greatest quality-adjusted expected survival, although this benefit decreases with increasing patient age. For a 35-year-old patient with intermediate-prognosis CML, transplantation within the first year results in 53 more discounted, quality-adjusted years of life expectancy than does no transplantation. This finding is robust even with varying baseline assumptions. CONCLUSIONS: These results support the use of early unrelated donor bone marrow transplantation for most patients with CML.
BACKGROUND:Chronic myelogenous leukemia (CML) is an indolent but ultimately fatal disease. Because the natural history of CML varies and quality of life with CML may be excellent until shortly before death, deciding whether and when to pursue unrelated donor bone marrow transplantation is often difficult. OBJECTIVE: To compare early transplantation, delayed transplantation, and no transplantation for patients with chronic-phase CML on the basis of discounted, quality-adjusted life expectancy. DESIGN: A markov model comparing different strategies was constructed. This model considers patient age, quality of life, risk aversion, and the competing risks for CML progression and transplant toxicity. SETTING: Therapeutic decision at the time of diagnosis of CML. PATIENTS: The base case is a 35-year-old patient with intermediate-prognosis CML. Younger and older patients with better and worse prognoses are also evaluated. INTERVENTION: Early transplantation, delayed transplantation, and no transplantation. MEASUREMENTS: Quality-adjusted, discounted life expectancy. RESULTS: For patients with newly diagnosed CML, transplantation within the first year provides the greatest quality-adjusted expected survival, although this benefit decreases with increasing patient age. For a 35-year-old patient with intermediate-prognosis CML, transplantation within the first year results in 53 more discounted, quality-adjusted years of life expectancy than does no transplantation. This finding is robust even with varying baseline assumptions. CONCLUSIONS: These results support the use of early unrelated donor bone marrow transplantation for most patients with CML.
Authors: John Koreth; Joseph Pidala; Waleska S Perez; H Joachim Deeg; Guillermo Garcia-Manero; Luca Malcovati; Mario Cazzola; Sophie Park; Raphael Itzykson; Lionel Ades; Pierre Fenaux; Martin Jadersten; Eva Hellstrom-Lindberg; Robert Peter Gale; C L Beach; Stephanie J Lee; Mary M Horowitz; Peter L Greenberg; Martin S Tallman; John F DiPersio; Donald Bunjes; Daniel J Weisdorf; Corey Cutler Journal: J Clin Oncol Date: 2013-06-24 Impact factor: 44.544
Authors: S Kurosawa; T Yamaguchi; T Mori; H Kanamori; Y Onishi; N Emi; S Fujisawa; A Kohno; C Nakaseko; B Saito; T Kondo; M Hino; Y Nawa; S Kato; A Hashimoto; T Fukuda Journal: Bone Marrow Transplant Date: 2015-06-15 Impact factor: 5.483
Authors: Joshua F Zeidner; Marianna Zahurak; Gary L Rosner; Christopher D Gocke; Richard J Jones; B Douglas Smith Journal: Leuk Lymphoma Date: 2014-06-16
Authors: Rebecca L Olin; Peter A Kanetsky; Thomas R Ten Have; Sunita D Nasta; Stephen J Schuster; Charalambos Andreadis Journal: Am J Hematol Date: 2010-04 Impact factor: 10.047
Authors: Jeroen P Jansen; Amy K O'Sullivan; Elly Lugtenburg; Lambert F R Span; Jeroen J W M Janssen; Wiro B Stam Journal: Ann Hematol Date: 2010-04-10 Impact factor: 3.673
Authors: Ursula Rochau; Martina Kluibenschaedl; David Stenehjem; Kuo Kuan-Ling; Jerald Radich; Gary Oderda; Diana Brixner; Uwe Siebert Journal: Leuk Res Treatment Date: 2015-12-10