Autologous bone marrow transplantation for acute myelogenous leukemia using 4-hydroperoxycyclophosphamide and VP-16 purged bone marrow.
Thirty adult patients with acute myelogenous leukemia (AML) in remission were treated with hyperfractionated total body irradiation, VP-16, and cyclophosphamide followed by infusion of autologous bone marrow purged with 4-hydroperoxycyclophosphamide and VP-16. Fifteen patients were transplanted in first remission (R1), 13 in second remission (R2), and two in third remission (R3). All patients had hematopoietic engraftment. The median time to achieve a white blood cell count of 1.0 x 10(9)/l and a neutrophil count of 500 x 10(6)/l was 32 days. The median time to achieve an unsupported platelet count of 50 x 10(9)/l was 70 days. There were four transplant-related deaths, all in patients in R2. Ten patients have relapsed, including both patients transplanted in R3. The disease-free survival (DFS) of all patients is 52%, median follow-up not yet reached. Although the number of patients in each group is small and follow-up is limited, there is a trend toward improved actuarial DFS in patients transplanted in R1 compared with patients transplanted in R2 (72 vs 39%; p = 0.081). Use of VP-16 in the conditioning regimen as well as in the purging procedure is feasible in the treatment of patients with AML.
Gulati
S
S
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Acaba
L
L
Yahalom
J
J
Reich
L
L
Motzer
R
R
Crown
J
J
Doherty
M
M
Clarkson
B
B
Berman
E
E
Atzpodien
J
J
D000328:Adult; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation; D003520:Cyclophosphamide / Q000031:analogs & derivatives*; D005047:Etoposide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
D005047:Etoposide; D003520:Cyclophosphamide; C011272:perfosfamide