This is the finding of researchers at the Medical College of Wisconsin in Milwaukee and The University of Texas M. D. Anderson Cancer Center.

In doing the study, the researchers wanted to know which treatment gives better results. Doctors have to make the decision regarding which treatment to use every time they treat a patient with this disease.

While they found a significant difference in treatment outcomes, they did not come to a hard-and-fast conclusion about which is better for all patients. Importantly, they provide significant information to make the decision easier for physicians and patients.

The results of the study were presented Monday at the annual meeting of the American Society of Hematology, held at the Orange County Convention Center in Orlando, Fl.

The researchers looked at two groups of patients. One group of 125 patients received a course of chemotherapy at M. D. Anderson Cancer Center for their blood cancer. Another group of 166 patients got a bone marrow transplant (BMT) from a sibling donor with whom they were HLA (Human Leucocyte Antigen) matched. These data were reported to the International Bone Marrow Transplant Registry (IBMTR) at the Medical College.

"The hope with a transplant is to cure the underlying disease," says Christopher Bredeson, M.D., M.S., assistant professor of medicine at the Medical College. "Chemotherapy, on the other hand, is not a cure. CLL has a long latency period so you can live a long time with it, maintained on chemotherapy, but few patients go into complete remission."

That means the relapse rate in chemotherapy patients is very high, while in the transplant patients it is much lower. That would seem to make a transplant the treatment of choice -- no question. But there is another factor to consider: there is up-front mortality with BMT. Between 20 percent and 40 percent of patients die of complications directly related to bone marrow transplant. One of these is Graft-vs-Host Disease (GVHD) which occurs when the cells from donor bone marrow attack the host cells it considers foreign.

"You can die from your transplant due to Graft-vs-Host Disease, infection or failure of the transplant to engraft. The issue is, is it worth the tradeoff? That's the difficulty doctors are having. They want to know what to tell their patients."

"It's a balancing act," Dr. Bredeson says. "In a young patient, a transplant may be worth the risk for long life. In an older patient who says 'I just want to see my grandson get married in the fall,' it may not be."

The transplant-related mortality in bone marrow patients in this study decreased rapidly after the first year post-transplant. Doctors hope to bring up-front mortality down with further refinement of the transplant process. But in the meantime, they will have to continue the balancing act in making a decision.

"We would not make a blanket recommendation; this is a choice the doctor and patient have to make," Dr. Bredeson says. "But this study provides them information doctors can use to advise patients based on the patient's individual status. We can't say, 'Take this pill and you'll be cured,' but the study gives evidence to doctors and patients to weigh."

Also working on the study with Dr. Bredeson were: Kathleen Sobocinski, M.S., associate director of statistics, IBMTR; Sergio Giralt, associate professor of medicine, and Michael Keating, M.D., B.S., professor of medicine, M. D. Anderson Cancer Center; Emilio Montserrat, M.D., professor of medicine, University of Barcelona, Spain; Mei-Jie Zhang, Ph.D., associate professor of biostatistics at the Medical College; Jerome Seidenfeld, Ph.D., Blue Cross Blue Shield Association; and Mary Horowitz, M.D., M.S., professor of neoplastic diseases and scientific director of the IBMTR.

11-Dec-2001