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Allogeneic bone marrow transplantation after high-dose busulfan and
cyclophosphamide in patients with acute nonlymphocytic leukemia
RB Geller, R Saral, S Piantadosi, M Zahurak, GB Vogelsang, JR Wingard, RF Ambinder, WB Beschorner, HG Braine and WH Burns
Johns Hopkins Oncology Center, Baltimore, MD 21205.
Ninety-nine patients with acute nonlymphocytic leukemia (ANLL) received
HLA-identical bone marrow transplants (BMTs) from sibling donors after
preparation with high doses of busulfan and cyclophosphamide. Forty- nine
patients were transplanted in first complete remission (CR), and 50
patients were transplanted in second and third CR and early relapse.
Fifty-three received one of three regimens containing primarily low- dose
cyclophosphamide (group I) for graft-v-host disease (GVHD) prophylaxis;
since March 1983, 46 patients received intravenous (IV) cyclosporine (group
II). After December 1983, only cytomegalovirus (CMV)-seronegative blood
products were used in appropriate patients, and since April 1984 patients
seropositive for herpes-simplex virus (HSV) and CMV received high-dose
acyclovir prophylaxis. For patients transplanted in first CR, there was a
significantly lower incidence of acute GVHD (P = .005) and deaths related
to GVHD and interstitial pneumonitis (P = .001) in patients in group II.
This was reflected in an improved Kaplan-Meier probability of disease-free
survival (DFS) in the 22 patients transplanted in group II as compared with
the 27 patients in group I (64% +/- 10% v 30% +/- 9%, P = .017). The
probability of remaining in remission was slightly lower in group II (82%
+/- 9% v 94% +/- 6%, P = .479). For patients transplanted in second and
third CR and early relapse, the incidence of acute GVHD (P = .026) and
deaths related to GVHD and interstitial pneumonitis was significantly lower
in group II (P = .029); the probability of remaining in remission was also
less (47% +/- 15% v 91% +/- 15%, P = .022). However, the probability of DFS
was not significantly different between the two groups (26% +/- 10% v 35%
+/- 18%, P = .957). We conclude that transplantation for patients in first
CR who received IV cyclosporine therapy is effective treatment; patients
with more refractory disease treated with the same cyclosporine regimen
(group II) had a lower incidence of GVHD than those treated in group I, but
survival did not improve because of an increase in the number of relapses
and other nonleukemic complications.
Volume 73,
Issue 8,
pp. 2209-2218,
06/01/1989
Copyright © 1989 by The American Society of Hematology
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