By Sandra Cohen MD, Stephen J. Forman MD (auth.), Robert J. Soiffer MD (eds.)

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Fefer A, Cheever MA, Thomas ED, et aL Disappearance of Ph(1)-positive cells in four patients with chronic granulocytic leukemia after chemotherapy, irradiation and marrow transplantation from an identical twin. N Engl J Med 1979;300(7):333-337. Fefer A, Cheever MA, Greenberg PD, et al. Treatment of chronic granulocytic leukemia with chemoradiotherapy and transplantation of marrow from identical twins. N EnglJ Med 1982;306(2):63-68. Goldman JM, Baughan ASJ, McCarthy DM, et al. Marrow transplantation for patients in the chronic phase of chronic granulocytic leukaemia.

Better outcomes are seen in younger patients who receive the transplant in earlier stages of their disease. With the limited available data, it is clear that this approach should be reserved for patients in whom matched unrelated donors are not available. , expansion, multiple cord transplants) and nonmyeloablative conditioning regimens, are under investigation and may contribute to improve the outcome of cord blood transplantation in the near future. 5. Autologous Transplantation Autologous BMT for CML has been investigated as an alternative strategy for patients lacking a suitable allogeneic donor.

Treating Relapse Treatment of patients that relapse after an alloBMT for CML has changed dramatically over the last 10 yr. Initially, only a second BMT was the only potential curative intervention, although few patients achieved durable remissions because of the high rates of morbidity and mortality (103,1 04). Interferon therapy was shown to reinduce remissions, in a proportion of patients who relapsed after allograft; although delays in disease progression were documented as well as achievement of complete cytogenetic remissions, the impact on survival was marginal at best (98,99).

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