title: Autologous bone marrow transplant in acute myeloid leukemia in first remission.
abstract: OBJECTIVE
  The Eastern Cooperative Oncology Group conducted a prospective study of postremission high-dose chemotherapy and autologous bone marrow transplantation (autoBMT) in a group of uniformly treated adults with de novo acute myeloid leukemia (AML) to evaluate whether intensive, myeloablative therapy in first complete remission (CR) could improve the disease-free survival.
  
  
  METHODS
  After initial CR was induced by the combination of daunorubicin, cytarabine, and thioguanine, patients not eligible for allogeneic bone marrow transplantation (alloBMT) were offered autoBMT. Within a median of 2 months after CR, and without intervening postremission therapy, bone marrow was obtained, purged by exposure to 4-hydroperoxycyclophosphamide (4-HC), and cryopreserved. High-dose therapy consisted of oral busulfan over 4 days (16 mg/kg total) followed by intravenous (IV) cyclophosphamide 50 mg/kg daily for 4 days. The cryopreserved marrow was then reinfused.
  
  
  RESULTS
  Of the 39 patients scheduled for autoBMT, four relapsed before transplantation. Two of the 35 (6%) transplant patients died of transplant-related complications, and 11 (33%) relapsed a median of 8 months after marrow reinfusion. No relapse has occurred after 24 months posttransplant. With a median follow-up of 31 months, the median disease-free survival period for all 39 patients has not been reached; however, 54% +/- 16% of patients are projected to be alive and disease-free at 3 years.
  
  
  CONCLUSIONS
  Long-term, disease-free survival after autoBMT in AML seems to be better than the outcome after conventional-dose postremission therapy and rivals the results of alloBMT.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia.
authors.forename: P A
authors.initials: PA
authors.lastname: Cassileth
authors.forename: J
authors.initials: J
authors.lastname: Andersen
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: O M
authors.initials: OM
authors.lastname: Colvin
authors.forename: J M
authors.initials: JM
authors.lastname: Bennett
authors.forename: E A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: H
authors.initials: H
authors.lastname: Kaizer
authors.forename: R S
authors.initials: RS
authors.lastname: Weiner
authors.forename: M
authors.initials: M
authors.lastname: Edelstein
authors.forename: M M
authors.initials: MM
authors.lastname: Oken
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000379:methods; D015925:Cryopreservation; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000601:surgery*; D015479:Leukemia, Myelomonocytic, Acute / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012074:Remission Induction; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome