Treatment of preleukemic syndromes with marrow transplantation
FR Appelbaum, R Storb, RE Ramberg, HM Shulman, CD Buckner, RA Clift, HJ Deeg, A Fefer, J Sanders and S Self
Thirty patients with advanced preleukemic syndromes were treated with
marrow transplantation. Most cases were diagnosed by the presence of
peripheral pancytopenia and a diagnostic marrow examination but in 6 of the
30 patients pretransplant chromosome studies were instrumental in
establishing the diagnosis. Three patients prepared for transplantation
with cyclophosphamide alone recurred with their disease within 6 months of
transplantation. The other 27 patients were treated with cyclophosphamide
and total body irradiation. Twenty of these 27 patients had preleukemia not
associated with prior therapy or severe marrow fibrosis. Thirteen of these
20 are alive and well 9 to 56 months from transplant and 7 died, 4 of
interstitial pneumonia, 2 of candida septicemia, and 1 of disseminated
zoster. There have been no disease recurrences in this group. The remaining
preleukemic patients, which include 3 patients transplanted for preleukemia
secondary to prior therapy and 4 patients transplanted for preleukemia
associated with severe marrow fibrosis, have all died. Major problems in
these patients included disease recurrence (2 cases) and, in those with
severe marrow fibrosis, graft failure (2 cases). These results suggest that
for patients with life-threatening pancytopenia due to spontaneous
preleukemia without severe marrow fibrosis, marrow transplantation can
prolong disease-free survival and may result in cure of the disease.
Volume 69,
Issue 1,
pp. 92-96,
01/01/1987
Copyright © 1987 by The American Society of Hematology
