Dose‐reduced conditioning for allografting in 44 patients with chronic myeloid leukaemia: a retrospective analysis

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Abstract
This retrospective study describes the outcome of patients with chronic myeloid leukaemia after allografting using dose‐reduced conditioning with fludarabine and busulphan. Forty‐four Philadelphia chromosome (Ph)‐positive patients were transplanted in nine German centres; 26 patients were in chronic phase, 11 in accelerated phase and seven in blast crisis. Thirty‐four patients achieved complete remission, with 18 alive and disease‐free at a median follow‐up of 562 d (range 244–922 d). Grade II–IV acute graft‐versus‐host disease (GVHD) incidence was 43%. Twenty patients died, 15 of causes unrelated to relapse. Risk factors predisposing to graft failure by univariate analysis were an unrelated donor (8/23 compared with a related donor 2/21, P = 0·07) and interferon therapy within 90 d of transplant (4/6 versus 3/17, P = 0·025). At the last follow‐up, of 31 patients for whom molecular or cytogenetic data were available, 16 (52%) were polymerase chain reaction‐negative, and seven (23%) were Ph‐negative by fluorescent in situ hybridization. These findings demonstrate that dose‐reduced conditioning with fludarabine and busulphan provides durable engraftment and a low rate of relapse. However, in this population, many of whom were not eligible for high‐dose conditioning due to age, reduced performance status, previous complications or extensive pre‐treatment, these data highlight the need for effective anti‐infectious and GVHD prophylaxis. In addition, this study supports the discontinuation of interferon therapy at least 90 d before transplant