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Long-Term Medical Outcomes and Quality-of-Life Assessment of Patients With Chronic Myeloid Leukemia Followed at Least 10 Years After Allogeneic Bone Marrow Transplantation

From the Bone Marrow Transplant Service, Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network, and the Population Health Sciences Research Institute, The Hospital for Sick Children and Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.

Address reprint requests to T.L. Kiss, MD, Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario M5G 2M9, Canada; email: thomas.kiss@ uhn.on.ca.

PURPOSE: Benchmark analysis of patients with chronic myeloid leukemia (CML) alive for more than 10 years after allogeneic bone marrow transplantation (BMT) including data on disease status, bone marrow reserve, long-term complications, and quality of life (QOL).

PATIENTS AND METHODS: Eighty-nine patients (46 in first chronic phase, 43 in advanced phase) received an allogeneic BMT for CML during the study period. Medical outcomes and QOL of patients were analyzed retrospectively.

RESULTS: Twenty-eight (31.5%) of 89 patients were alive at 10 years and included in this analysis. Thirteen (46.4%) of 28 long-term survivors never relapsed. Fifteen patients relapsed between 0.5 and 16 years after transplantation. Ten patients showed a hematologic relapse and received salvage treatment. Five patients showed transient low levels of BCR-ABL–positive cells by Southern blot with no subsequent hematologic relapse. One of the 28 patients died in blast crisis at 12 years. The most frequent long-term complications were chronic graft-versus-host disease, osteoporosis, and cataracts. Frequency of clonogenic progenitors remained persistently decreased. QOL assessment yielded lower scores in physical performance as compared with an age-matched normative population, whereas social functioning was equivalent. A high degree of satisfaction was noted with interpersonal relationships.

CONCLUSION: Patients with CML surviving their BMT long term do well in terms of medical outcomes. A constant rate of relapse was noted, with a high salvage rate of affected patients, suggesting the need for lifelong monitoring. QOL is perceived as good, particularly as related to social functioning; however, it is inferior to a normative population with regard to physical performance.

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