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Disease-free survival after autologous bone marrow transplantation in
patients with acute myelogenous leukemia
M Korbling, W Hunstein, TM Fliedner, S Cayeux, B Dorken, D Fehrentz, R Haas, AD Ho, U Keilholz and W Knauf
Department of Internal Medicine V, Heidelberg University, Federal Republic
of Germany.
Autologous bone marrow transplantation (ABMT) makes it possible to escalate
the dose of cytotoxic treatment to a lethal range. Disease- free survival
(DFS) following myeloablative therapy and ABMT has been shown to be
superior to conventional treatment in high risk patients with acute
myelogenous leukemia (AML). It was the purpose of the present study to
compare hematopoietic reconstitution, actuarial DFS, and relapse rate of
patients transplanted in first complete remission (CR) of AML with those in
second or subsequent CR, and to evaluate transplant related mortality.
Fifty-two patients with AML, 22 in first CR (low risk) and 30 in second or
subsequent CR (high risk), underwent total body irradiation (12.1 to 16.7
Gy) and cyclophosphamide (CY) treatment (200 mg/kg) followed by ABMT. The
autograft was incubated with the active CY derivative Mafosfamide (ASTA
Werke, Bielefeld, Federal Republic of Germany) to reduce the number of
possibly contaminating clonogenic tumor cells. All patients showed three
lineage engraftments with platelet recovery observed as being the slowest.
The transplant related death rate was low at 5.8%. There was no significant
difference in the kinetics of polymorphonuclear (PMN) cell or platelet
reconstitution between the low and high risk patient subgroups. The
estimated probability of DFS (relapse) after ABMT in first CR was 61% (36%)
compared with 34% (65%) in second or subsequent CR, the longest follow-up
being 55 months and 57 months, respectively (median follow-up 31 months and
19 months, respectively). ABMT offers a stable long-term DFS when performed
in first CR with no relapses occurring in over a year after
transplantation. Six later relapses, however, were seen after ABMT in
second or subsequent CR, although DFS was not statistically different from
that of first remission patients (P = .72).
Volume 74,
Issue 6,
pp. 1898-1904,
11/01/1989
Copyright © 1989 by The American Society of Hematology
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