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Allogeneic bone marrow transplantation for acute myeloid leukemia in first
remission: a randomized trial of a busulfan-Cytoxan versus Cytoxan-total
body irradiation as preparative regimen: a report from the Group d'Etudes
de la Greffe de Moelle Osseuse [see comments]
D Blaise, D Maraninchi, E Archimbaud, J Reiffers, A Devergie, JP Jouet, N Milpied, M Attal, M Michallet and N Ifrah
Statistical Department, Institut Paoli Calmettes, Marseille, France.
From October 1987 to December 1990, 101 patients with acute myeloid
leukemia (AML) were randomized to be transplanted in first complete
remission (CR1). Preparative regimen including Cytoxan (120 mg/kg) with
total body irradiation (CYTBI) (N = 50) or busulfan (16 mg/kg) (BUSCY) (N =
51) was followed by allogeneic bone marrow transplantation (BMT) from an
HLA-identical sibling. Mean time between diagnosis and BMT was 119 days.
The outcome for CYTBI at 2 years is better for probability of disease-free
survival (DFS) (72% v 47%) (P less than .01), survival (75% v 51%) (P less
than .02), relapse (14% v 34%) (P less than .04), and transplant mortality
(8% v 27%) (P less than .06). In multivariable analysis, higher relapse and
decreased survival and DFS were associated with BUSCY regimen, while
chronic graft-versus-host disease also influenced independently the
probability of relapse. This demonstrates the present limitation of
busulfan use in this setting, possibly due to probable individual
variations in biodisponibility. Furthermore, besides the anti-leukemic
effect of preparative regimens, this trial points out the progress
accomplished in BMT management (transplant mortality = 8% in CYTBI) over
the last 20 years as well as the effectiveness of transplant in early first
CR after CYTBI (DFS = 72% at 2 years).
Volume 79,
Issue 10,
pp. 2578-2582,
05/15/1992
Copyright © 1992 by The American Society of Hematology
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Related Letter in Blood Online:
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Long-term follow-up of a randomized trial comparing the combination of cyclophosphamide with total body irradiation or busulfan as conditioning regimen for patients receiving HLA-identical marrow grafts for acute myeloblastic leukemia in first complete remission
- Didier Blaise, Dominique Maraninchi, Mauricette Michallet, Josy Reiffers, Jean Pierre Jouet, Noël Milpied, Agnes Devergie, Michel Attal, Jean Jacques Sotto, Mathieu Kuentz, Norbert Ifrah, Charles Dauriac, Pierre Bordigoni, Nicole Gratecos, François Guilhot, Denis Guyotat, Eliane Gluckman, and Jean Paul Vernant
Blood 2001 97: 3669-3671.
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