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Autologous bone marrow transplantation for acute myelocytic leukemia in
first remission: a European survey of the role of marrow purging
NC Gorin, P Aegerter, B Auvert, G Meloni, AH Goldstone, A Burnett, A Carella, M Korbling, P Herve and D Maraninchi
Department of Hematology, Hopital Saint Antoine, Paris, France.
We analyzed data from 263 patients with acute myelocytic leukemia (AML)
autografted in first remission (CR) during the period from January, 1982 to
January, 1987 at one of 34 centers in the European Bone Marrow Transplant
Group. The median age of patients was 30 years (range, 1 to 65). The median
interval between achieving CR and autografting was 5 months (range, 1 to
23). Of the 263 patients, 131 patients received cytoreductive regimens that
included total body irradiation (TBI); the remainder received various
combinations of cytotoxic drugs. Sixty-nine patients received autologous
marrow purged in vitro with mafosfamide, and 194 received unpurged marrow.
The median follow-up was 28 months (range, 12 to 97). For patients with
standard risk AML in CR1 autografted after TBI (n = 107), the leukemia-free
survival (LFS) was higher, and the probability of relapse was lower in
recipients of purged than of unpurged marrow (63% versus 34%, P = .05 and
23% versus 55%, relative risk 0.34, P = .005, respectively). The superior
results of purging were most obvious in patients autografted within 6
months of achieving CR (probability of relapse, 20% versus 61%, P = .01).
Patients with longer intervals between CR and autografting had higher LFS
and lower probability of relapse than those autografted early in CR
(intervals greater than 9 months, 7 to 9 months, 4 to 7 months, and less
than or equal to 3 months: LFS = 56%, 40%, 35%, 27%, P = .007, probability
of relapse = 25%, 56%, 59%, 67%, P = .005; respectively). We conclude that
marrow purging with mafosfamide may be valuable for patients autografted
early in first CR.
Volume 75,
Issue 8,
pp. 1606-1614,
04/15/1990
Copyright © 1990 by The American Society of Hematology
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