Excellent disease eradication by myeloablative therapy and stem-cell transplantation in patients with acute myelogenous leukemia.
Between February 1982 and 1999, 118 consecutive patients (65 male, 53 female) with acute myelogenous leukemia (AML), with a median age of 35 years (range 17-56 years), received stem-cell grafts from a human leukocyte antigen-identical sibling (n = 71), one-antigen-mismatched family member (n=2), matched unrelated donor (n=15), one-antigen-mismatched unrelated donor (n = 4) or an autologous (n = 26) graft. At the time of transplant, 56 patients were in the first complete remission (CR), 27 in the second CR, 6 in untreated relapse, 17 in primary refractory, and 12 in refractory relapse. The French-American-British classification (FAB) subtypes were as follows: M1 (n=25), M2 (n=28), M3 (n=11), M4 (n =32), M5 (n=16), M6 (n = 6). For conditioning, most patients underwent total body irradiation-containing regimens. As of 28 February, 1999, probability of leukemia-free survival (LFS) is 58% for patients after related and 45% after unrelated stem-cell transplantation (SCT). The probability of LFS is 70% for patients given allogeneic transplants in the first CR compared with 33% for those beyond the first CR at SCT. In autologous stem-cell graft recipients, the probability of LFS is 37%. Transplant-related mortality was 28% after related, 20% after unrelated, and 4% after autologous SCT. Probability of relapse for patients given related-donor stem-cell grafts in the first CR and beyond the first CR is 30% and 67%, 55% after unrelated and 63% after autologous stem-cell grafting. Thus, myeloablative therapy followed by allogeneic stem-cell infusion has a high curative potential for patients with AML in remission and offers substantial benefits to patients in advanced disease.
Greinix
H T
HT
Department of Medicine I, University of Vienna, Austria. hildegard.greinix@akh-wien.ac.at
Loidolt
H
H
Rabitsch
W
W
Schulenburg
A
A
Keil
F
F
Mitterbauer
M
M
Laczika
K
K
Lechner
K
K
Dieckmann
K
K
Fischer
G
G
Jäger
U
U
Rosenmayr
A
A
Knöbl
P
P
Schwarzinger
I
I
Höcker
P
P
Mannhalter
C
C
Hinterberger
W
W
Haas
O A
OA
Fonatsch
C
C
Kalhs
P
P
D000293:Adolescent; D000328:Adult; D002884:Chromosomes, Human, Pair 15; D002886:Chromosomes, Human, Pair 17; D005260:Female; D015321:Gene Rearrangement; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D018365:Neoplasm, Residual / Q000503:physiopathology; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014178:Translocation, Genetic; D014182:Transplantation, Autologous / Q000401:mortality; D014184:Transplantation, Homologous / Q000401:mortality
D019653:Myeloablative Agonists