Autologous bone marrow transplantation for acute myeloid leukemia using
busulfan plus etoposide as a preparative regimen
CA Linker, CA Ries, LE Damon, HS Rugo and JL Wolf
University of California, San Francisco 94143.
We have studied the use of a new preparative regimen for the treatment of
patients in remission of acute myeloid leukemia (AML) with autologous bone
marrow transplantation. Chemotherapy consisted of busulfan 1 mg/kg every 6
hours for 4 days (total dose, 16 mg/kg) on days -7 through -4 followed by
an intravenous infusion over 6 to 10 hours of etoposide 60 mg/kg on day -3.
Autologous bone marrow, treated in vitro with 100 micrograms/mL of
4-hydroperoxycyclophosphamide, was infused on day 0. We have treated 58
patients up to the age of 60 years, 32 in first remission, 21 in second or
third remission, and 5 with primary refractory AML unresponsive to
high-dose Ara-C, but achieving remission with aggressive salvage regimens.
Of the first remission patients, there has been 1 treatment related death
and 5 relapses. With median follow-up of 22 months, the actuarial relapse
rate is 22% +/- 9% and disease-free survival is 76% +/- 9% at 3 years.
Patients with favorable French-American-British (FAB) subtypes (M3 or M4
EO) did especially well, with no relapses seen in 15 patients observed for
a median of 30 months. Actuarial relapse rate at 3 years was 48% for first
remission patients with less favorable FAB subtypes. Of patients in second
or third remission, there were 5 treatment related deaths and 4 relapses.
With median follow-up of 22 months, the actuarial relapse rate is 25% +/-
11% and disease-free survival is 56% +/- 11% at 3 years. Four of five
primary refractory patients died during treatment and 1 remains in
remission with short follow-up. These preliminary data are very encouraging
and, if confirmed, support the use of autologous purged bone marrow
transplantation using aggressive preparative regimens as one approach to
improve the outcome of adults with AML.
Volume 81,
Issue 2,
pp. 311-318,
01/15/1993
Copyright © 1993 by The American Society of Hematology
