Autologous bone marrow transplantation in acute myeloid leukemia in first remission: results of a Dutch prospective study
| Autor: | Pieter Sonneveld, J Abels, F E Zwaan, J van der Lelie, Roelof Willemze, A. W. Dekker, Goudsmit R, Bob Löwenberg, L J Verdonck, M de Planque |
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| Rok vydání: | 1990 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Adolescent medicine.medical_treatment chemical and pharmacologic phenomena Human leukocyte antigen Gastroenterology Actuarial Analysis Bone Marrow immune system diseases hemic and lymphatic diseases Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Platelet Prospective Studies Prospective cohort study Bone Marrow Transplantation Netherlands Chemotherapy business.industry Remission Induction Myeloid leukemia hemic and immune systems Middle Aged Autologous bone Surgery Survival Rate Transplantation Radiation therapy Leukemia Myeloid Acute surgical procedures operative Oncology business Whole-Body Irradiation Follow-Up Studies |
| Zdroj: | Journal of Clinical Oncology. 8:287-294 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | Recent investigations have suggested a role for marrow ablative chemotherapy and radiotherapy given with autologous bone marrow transplantation (auto-BMT) in the treatment of acute myeloid leukemia (AML), but prospective studies have not been reported. We assessed the comparative values of auto-BMT and allogeneic marrow transplantation (allo-BMT) in 117 15- to 60-year-old consecutive patients (median, 43 years) with AML following remission-induction therapy. In 32 cases of the 90 (77%) complete responders, auto-BMT (nonpurged) was undertaken at a median of 3.8 months and in 23 eligible cases human leukocyte antigen (HLA)-matched allo-BMT occurred at 3.0 months after attainment of remission. Thus, nearly 60% of complete responders had access to transplantation, the others being withdrawn because of relapse, refusal, or other causes. Median time of regeneration to neutrophils 0.5 x 10(9)/L and platelets 20 x 10(9)/L were 39 and 63 days following auto-BMT versus 21 and 19 days after allo-BMT, respectively. AML relapse was the predominant cause of failure after auto-BMT (17 of 32) and procedure-related death was seen in three of 32 patients. The actuarial rates of relapse at 3 years are 60% (auto-BMT) and 34% (allo-BMT) (log-rank, P = .03). Patients treated with auto-BMT and allo-BMT have an overall survival of 37% and 66% at 3 years posttransplant, respectively (P = .05). Relapse-free 3-year survival rates are 35% and 51%, respectively (P = .12). Survival of the nongrafted complete responders is less than 10%. This study shows that allo-BMT in adult patients with AML in first complete remission (CR) results in more rapid hematopoietic reconstitution, is followed by fewer recurrences, and provides better survival than auto-BMT. |
| Databáze: | OpenAIRE |
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