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SLIDES
& TRANSCRIPTS
Monday,
May 12, 2003
Allogeneic
and autologous SCT
Anthony
Goldstone, M.R.C.P.
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| Slide
1: |
 Thank
you. We have now over 250 PH positive patients. Their overall
survival at seven years, all treatment included -- this is shown
overall -- together is 21 percent.
This is the
overall survival by the treatment in first remission. The top
line, related donor transplant trials, the second line, unrelated
donor transplants, and the third line, if you are in the chemotherapy
stroke ABMT arm.
For all the
patients at all ages with no allowance of time to transplant,
then there is a superiority in overall survival for related or
unrelated transplants against chemotherapy or ABMT.
You can see
with the 206 patients on whom we have data up to last October,
the numbers out at five years are very small indeed.
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| Slide
2: |
|  This
is the EFS, again, for the same three groups, showing the differences
between the matched and the unrelated donors greater than that for
the chemo ABMT arm.
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| Slide
3: |
|  If,
on the other hand, you censor all the chemo ABMT patients over the
age of 50, because transplant was allowed only up until 50 years,
and the allogeneic transplants, whereas patients got chemo ABMT
up to the age of 60 years.
If you censor
it only to include patients up to the age of 50 years, and you exclude
the chemo auto patients with relapse in fewer than the median number
of days to transplant, which was 163 days, then, although the related
and the unrelated transplants were in the same order versus the
chemo ABMT arm, for overall survival, the significant differences
disappear, again possibly because the numbers out to the right of
the curve are very small.
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| Slide
4: |
|  For
event-free survival, each of the transplants are still significantly
superior to chemo ABMT. Again, some of the differences disappeared
by keeping the patient numbers below 50 years, and censoring the
patients in the time to transplant bias.
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| Slide
5: |
|  Again,
the graft versus leukemia effect is shown here, by the risk of relapse
by treatment received in first remission, which shows that, for
both the transplant arms, the matched and matched unrelated, they
have a far superior relapse rate in the chemo ABMT arm, which is
up here.
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| Slide
6: |
|  Despite
this extremely large study, the number of Ph positive patients who
received an auto transplant in first remission is very small, only
11 patients.
I do want to
make the point that there are patients alive, one out at four years,
and two out at over three-and-a-half years. So, of five alive, three
are more than three-and-a-half years out, and auto transplant in
first remission for these patients, on these data, can't be excluded
as a potential useful treatment for Ph positive patients.
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| Slide
7: |
|  This
is the small group of five patients who had an allogeneic transplant
without reaching remission, and the message is that they all died.
The next slide,
which I think is the last,
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| Slide
8: |
|  30
patients received a transplant after relapse, 14 related donor,
14 unrelated donor, one auto transplant, one unknown, one not-UK
patient.
Twenty-four
of the 30 are dead already, but six are alive, three related donors
and three unrelated donors. Of those who are alive, two are out
at six years and two are out at four years. So, a small number of
patients can do well.
If the relapse
occurs early, the median survival is 200 days post-transplant, and
if the relapse occurs rather later, the median survival is rather
more, but there is no significant difference between them.
So, the message
is this, that all modalities of treatment can rescue some of these
patients. There appears a superior benefit to allogeneic transplants,
either matched or unrelated, versus chemotherapy or ABMT.
This is far
from clear because the numbers are small at more than five years
out, so it is not completely clear, the superiority of transplant
yet.
However, in
terms of relapse rate for both kinds of allogeneic transplant, the
graft versus leukemia effect is significant.
A few patients
can be rescued by ABMT and a few patients can be rescued by some
sort of transplant after relapse. Thank you.
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