title: In vivo purging with high-dose cytarabine followed by high-dose chemoradiotherapy and reinfusion of unpurged bone marrow for adult acute myelogenous leukemia in first complete remission.
abstract: OBJECTIVE
  To evaluate in a prospective study the efficacy of autologous bone marrow transplantation (BMT) in adult patients with acute myelogenous leukemia (AML) in first remission, using a single course of high-dose Cytarabine (HD Ara-C) consolidation therapy as in vivo purging.
  
  
  METHODS
  Sixty consecutive adult patients with AML in first complete remission (CR) were treated with HD Ara-C consolidation therapy as a method of in vivo purging before marrow collection. High-dose therapy consisted of fractionated total-body irradiation (FTBI) 12 Gy, intravenous etoposide 60 mg/kg, and cyclophosphamide 75 mg/kg, followed by reinfusion of cryopreserved marrow.
  
  
  RESULTS
  Sixty patients underwent consolidation treatment with HD Ara-C with the intent to treat with autologous BMT. Sixteen patients were unable to proceed to autologous BMT (10 patients relapsed, one died of sepsis, one developed cerebellar toxicity, two had inadequate blood counts, and two refused). Forty-four patients underwent autologous BMT and have a median follow-up time of 37 months (range, 14.7 to 68.7) for patients who are alive with no relapse. The cumulative probability of disease-free survival (DFS) at 24 months in the intent-to-treat group is 49% (95% confidence interval [CI], 37% to 62%) and in those who actually underwent autologous BMT is 61% (95% CI, 46% to 74%). The probability of relapse was 44% (95% CI, 31% to 58%) and 33% (95% CI, 20% to 49%) for the intent-to-treat and autologous BMT patients, respectively.
  
  
  CONCLUSIONS
  This approach offers a relatively high DFS rate to adult patients with AML in first CR. The results of this study are similar to those achieved with allogeneic BMT.
authors.affiliation: Department of Hematology/Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA. ASTEIN@SMTPLINK.COH.ORG.
authors.forename: A S
authors.initials: AS
authors.lastname: Stein
authors.forename: M R
authors.initials: MR
authors.lastname: O'Donnell
authors.forename: A
authors.initials: A
authors.lastname: Chai
authors.forename: G M
authors.initials: GM
authors.lastname: Schmidt
authors.forename: A
authors.initials: A
authors.lastname: Nademanee
authors.forename: P M
authors.initials: PM
authors.lastname: Parker
authors.forename: E P
authors.initials: EP
authors.lastname: Smith
authors.forename: D S
authors.initials: DS
authors.lastname: Snyder
authors.forename: A
authors.initials: A
authors.lastname: Molina
authors.forename: D E
authors.initials: DE
authors.lastname: Stepan
authors.forename: R
authors.initials: R
authors.lastname: Spielberger
authors.forename: G
authors.initials: G
authors.lastname: Somlo
authors.forename: K A
authors.initials: KA
authors.lastname: Margolin
authors.forename: N
authors.initials: N
authors.lastname: Vora
authors.forename: J
authors.initials: J
authors.lastname: Lipsett
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Niland
authors.forename: S J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016465:Bone Marrow Purging / Q000379:methods; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage* / Q000627:therapeutic use; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012044:Regression Analysis; D012074:Remission Induction; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide