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KJ Selvaggi, JW Wilson, LE Mills, GG Cornwell , D Hurd, W Dodge, R Gingrich, SE Martin, R McMillan and W Miller
Division of Hematology/Bone Marrow Transplantation, University of
Pittsburgh Medical Center, PA 15213.
We have conducted a 9-year multicenter trial of autologous bone marrow
transplantation (ABMT) for acute myeloid leukemia (AML). Remission BM was
purged in vitro using monoclonal antibodies (MoAbs; PM-81, AML-2- 23) and
complement targeting myeloid differentiation antigens (CD15, CD14). In
1988, the preparative regimen changed from 60 mg/kg/d cyclophosphamide x 2
and fractionated total body irradiation (TBI) total dose, 1,200 cGy
(Cy/fTBI), to 4 mg/kg/d busulfan x 4 and 60 mg/kg/d Cy x 2 (Bu/Cy2). Recent
analysis (October 1, 1993) shows that the Bu/Cy2 regimen along with the
same MoAb purging method yields an improved outcome. Seven first
complete-remission (CR) (CR1), 45 second- or third-CR (CR2/3), and 11
first-relapse (R1) patients were treated with chemotherapy and TBI or
chemotherapy alone followed by ABMT with MoAb-purged BM. Median age at ABMT
for those patients in CR 2/3 and R1 patients was 36 years. Twenty-nine CR
2/3 and R1 patients were conditioned with Cy/fTBI, and 27 CR2/3 and R1
patients were conditioned with Bu/CY. Using the Kaplan-Meier method, the
CY/fTBI, CR2/3, and R1 patients have a 3-year disease-free survival (DFS)
of 21%. On the other hand, the Bu/Cy2, CR2/3, and R1 patients have a 3-year
DFS of 48%. Nineteen CR2/3 and R1 patients relapsed post-ABMT. On analysis
by conditioning regimen, those treated with Cy/fTBI have a 3-year relapse
rate (RR) of 58%, whereas the patients conditioned with Bu/Cy2 have a 39%
3-year RR. Long-term DFS can be achieved in about 50% of patients with
advanced remissions and relapsed AML using Bu/Cy2 with MoAb-purged BM.
This article has been cited by other articles:
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| Copyright © 1994 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||
