title: Feasibility and results of bone marrow transplantation after remission induction and intensification chemotherapy in de novo acute myeloid leukemia. Catalan Group for Bone Marrow Transplantation.
abstract: OBJECTIVE
  To evaluate prospectively the feasibility and results of bone marrow transplantation (BMT) after induction and intensification chemotherapy (CT) in patients with de novo acute myeloid leukemia (AML).
  
  
  METHODS
  A total of 159 patients less than 51 years of age were treated. Induction CT consisted of daunorubicin 60 mg/m2 for 3 days, cytarabine (ARA-C) 100mg/m2 for 7 days, and etoposide 100 mg/m2 for 3 days. The first intensification therapy included mitoxantrone 10 mg/m2 for 3 days and ARA-C 1.2 g/m2 every 12 hours for 4 days. Amsacrine (100 or 150 mg/m2 for 3 days) and ARA-C (1.2 g/m2 every 12 hours for 2 or 4 days) were given as the second intensification therapy. Depending on the availability of a human leukocyte antigen (HLA)-identical sibling, the intention of treatment after CT was allogeneic BMT (allo-BMT) or autologous BMT (ABMT).
  
  
  RESULTS
  Complete remission (CR) was obtained in 120 patients (75%) and partial remission (PR) in 11 (7%), while 15 patients (10%) were refractory and 13 (8%) died during induction. There was a trend for better leukemia-free survival (LFS) at 4 years for patients assigned to the ABMT group (50% +/- 6%) compared with the allo-BMT group (31% +/- 7%) (P = .08). This difference in LFS reached statistical significance when considering only transplanted patients (63% +/- 3% at 4 years after ABMT and 38% +/- 11% after allo-BMT, P = .02). The favorable results in patients who received ABMT (no toxic deaths and 37% +/- 7% probability of relapse at 4 years) contrast with the poor outcome of allografted patients (11 patients with transplant-related mortality).
  
  
  CONCLUSIONS
  Our study reflects the difficulties in the completion of a therapeutic strategy that include BMT and suggests that intensification before BMT may be useful in the setting of ABMT, but this approach was associated with a high mortality rate in allo-BMT patients.
authors.affiliation: Hospital Clinic, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.forename: S
authors.initials: S
authors.lastname: Brunet
authors.forename: A
authors.initials: A
authors.lastname: Grañena
authors.forename: T
authors.initials: T
authors.lastname: Olivé
authors.forename: J
authors.initials: J
authors.lastname: Bueno
authors.forename: J M
authors.initials: JM
authors.lastname: Ribera
authors.forename: J
authors.initials: J
authors.lastname: Petit
authors.forename: C
authors.initials: C
authors.lastname: Besses
authors.forename: A
authors.initials: A
authors.lastname: Llorente
authors.forename: R
authors.initials: R
authors.lastname: Guardia
authors.forename: J
authors.initials: J
authors.lastname: Macía
authors.forename: M
authors.initials: M
authors.lastname: Rovira
authors.forename: I
authors.initials: I
authors.lastname: Badell
authors.forename: E
authors.initials: E
authors.lastname: Vela
authors.forename: C
authors.initials: C
authors.lastname: Díaz de Heredia
authors.forename: P
authors.initials: P
authors.lastname: Vivancos
authors.forename: E
authors.initials: E
authors.lastname: Carreras
authors.forename: E
authors.initials: E
authors.lastname: Feliu
authors.forename: E
authors.initials: E
authors.lastname: Montserrat
authors.forename: A
authors.initials: A
authors.lastname: Julía
authors.forename: J
authors.initials: J
authors.lastname: Cubells
authors.forename: C
authors.initials: C
authors.lastname: Rozman
authors.forename: A
authors.initials: A
authors.lastname: Domingo
authors.forename: J J
authors.initials: JJ
authors.lastname: Ortega
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome