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Transplantation in chronic myeloid leukaemia

2002; Elsevier BV; Volume: 359; Issue: 9307 Linguagem: Inglês

10.1016/s0140-6736(02)07831-5

1474-547X

Aloïs Gratwohl, Helen Baldomero, Álvaro Urbano‐Ispizua,

Chronic Lymphocytic Leukemia Research

The European Group for Blood and Marrow Transplantation (EBMT) has done a survey on transplant numbers in Europe every year since 1990. Information is obtained according to indication, donor type, and stem cell source for the preceding year. These surveys, which are published regularly, cover more than 95% of all transplants in Europe and provide a synopsis of current practice and trends.1Gratwohl A Passweg J Baldomero H Urbano-Ispizua A Hematopoietic stem cell transplantation activity in Europe.Bone Marrow Transplant. 2001; 27: 899-916Crossref PubMed Scopus (70) Google Scholar Data from the 2000 survey point to a new phenomenon. So far, chronic myeloid leukemia (CML) has been the leading indication for allogeneic transplants, with an annual increase of about 100 transplants per year. In 2000, however, the number fell by about 150 transplants, corresponding to a reduction of about 10%. This change took place despite a continuing rise in overall transplant activity. Even more striking was the decline in autologous transplants for CML with less than 50% of numbers in 2000 compared with 1999. The decline in CML transplant numbers coincides with the introduction of imatinib, a disease-specific tyrosine kinase inhibitor. Phase I data, published in spring, 2001, document its clinical efficacy.2Goldman JM Melo JV Targeting the BCR-AbL tyrosine kinase in chronic myeloid leukemia.N Engl J Med. 2001; 344: 1084-1086Crossref PubMed Scopus (220) Google Scholar This compound will change current strategies in CML treatment and alter wider cancer treatment. The decline in transplants preceded the first publication of clinical data in this field by a year, which is a notable observation. For such a disease as CML, long-term observations are essential for final assessments of treatment strategies, and transplants are the only therapeutic approach with the potential for cure. A similar change in transplant activity was noted a few years ago with autologous transplants for breast cancer. Numbers rose substantially from 1993, then declined in 1998. The increase and decrease began about 1–2 years before the key publications appeared.3Stadtmauer EA O'Neill A Goldstein LJ et al.Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer.N Engl J Med. 2000; 342: 1069-1076Crossref PubMed Scopus (405) Google Scholar Moreover, the debate on the usefulness of transplants in breast cancer is still not settled. Such changes in transplantation activity for specific indications within a short period are of interest. Decisions in the respective institutions for breast cancer and CML seem to have been affected more by expectation than by evidence-based medicine criteria, and followed stock-market patterns–anticipation drives decisions. These changes arose in an area of advanced medicine at its highest scientific and technological level. It might be time to integrate into medical decision making some of the motives that drive decisions at the stock exchange. Anticipatory decisions are not bad or necessarily based on rational criteria, but physicians and patients should be aware of them. Hopefully, the results for CML will meet the expectations.