title: High-dose chemotherapy and autologous bone marrow transplantation in acute myeloid leukemia.
abstract: For younger patients with acute myeloid leukemia (AML), an allogeneic transplant from a matched sibling may afford the best chance of cure. In patients who are older or without a matched sibling donor, dose intensification can be achieved with an autologous bone marrow transplant (ABMT). We report here the results of a high-dose chemotherapy regime with nonpurged ABMT in 82 adult patients in first remission of AML with a median follow-up of 31 months. The median age was 40 years (range 16 to 57 years). The median interval between remission and ABMT was 5 months (range 1 to 12 months). Twenty-eight of these patients received a second course of the same high-dose chemotherapy and ABMT. The procedure related mortality rate was 6%. The projected leukemia-free survival (LFS) at 5 years is 48% for all 82 patients and 50% for the 76 patients with no known preceding myelodysplastic syndrome. For those patients with primary AML who received a double ABMT the projected LFS is 67%. The interval between remission and ABMT did not predict for either relapse or LFS. ABMT using a multidrug chemotherapy protocol is less toxic than allogeneic BMT yet results in a similar LFS.
authors.affiliation: University College and Middlesex Schools of Medicine, Leicester, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: McMillan
authors.forename: A H
authors.initials: AH
authors.lastname: Goldstone
authors.forename: D C
authors.initials: DC
authors.lastname: Linch
authors.forename: J G
authors.initials: JG
authors.lastname: Gribben
authors.forename: K G
authors.initials: KG
authors.lastname: Patterson
authors.forename: J D
authors.initials: JD
authors.lastname: Richards
authors.forename: I
authors.initials: I
authors.lastname: Franklin
authors.forename: B J
authors.initials: BJ
authors.lastname: Boughton
authors.forename: D W
authors.initials: DW
authors.lastname: Milligan
authors.forename: M M
authors.initials: MM
authors.lastname: Leyland
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000627:therapeutic use*; D003630:Daunorubicin / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006410:Hematopoiesis / Q000187:drug effects; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014182:Transplantation, Autologous / Q000401:mortality / Q000473:pathology; D014184:Transplantation, Homologous / Q000401:mortality / Q000473:pathology
chemical_list: D003561:Cytarabine; D003630:Daunorubicin