Therapeutic choices in younger patients with chronic myelogenous leukemia

BACKGROUND. Allogeneic stem cell transplantation (SCT) and interferon (IFN)-α therapy have significantly improved the prognosis of patients with Philadelphia (Ph) chromosome positive chronic myelogenous leukemia (CML). Both therapies may be suitable for younger patients. The authors reviewed current data to assist in prioritizing these modalities in an individual patient. METHODS. The authors reviewed and summarized current data on outcomes of SCT and IFN-α therapy in patients with early chronic phase CML. RESULTS. Several disease-, patient-, and physician-related factors affect outcomes with both modalities. Interferon-α does not induce myelofibrosis. The course of CML is predictable in most patients; sudden emergence of blastic phase; disease is unusual. There is no significant adverse impact of delaying SCT for the 12 months usually necessary to assess cytogenetic response to an IFN-α-based regimen. Interferon-α may be discontinued some months before SCT and is not associated with an adverse impact on post-SCT outcomes. CONCLUSIONS. An individualized risk assessment-based approach is of value in prioritizing SCT and IFN-α in younger patients with chronic phase CML. The authors recommend a risk-based therapy algorithm based on the expected SCT associated 1-year mortality for an individual patient. (C) 2000 American Cancer Society.