Unrelated donor marrow transplantation for acute myeloid leukemia: an update of the Seattle experience.
Between 1985 and 1998, 161 patients with primary acute myeloid leukemia (AML) received T-replete bone marrow transplantation (BMT) from unrelated donors in Seattle. Median age was 30 (range 1-55) years. Conditioning for BMT consisted of cyclophosphamide and total body irradiation in 154 (96%) cases and graft-versus-host disease prophylaxis was the standard methotrexate and cyclosporine combination in 134 (83%) cases. Median post-transplant follow-up was 2.9 years. Leukemia-free survival (LFS) at 5 years was 50+/-12% for transplants during first complete remission (n = 16), 28+/-8% during second CR (n = 40), 27+/-17% during subsequent CR (n = 8), 7+/-3% during relapse (n = 81) and 19+/-10% during primary induction failure (n = 16). The cumulative incidences of relapse were 19%, 23%, 25%, 44% and 63%, for the five groups, respectively. Transplantation during remission, a marrow cell dose above 3.5 x 10(8)/kg, and cytomegalovirus seronegative status before BMT in both patient and donor were favorable prognostic factors. Adults in any CR who received a marrow cell dose above 3.5 x 10(8)/mg had a LFS of 54+/-9% at 5 years. These data extend our previous findings on the association between a high marrow cell dose and improved survival and support the use of unrelated donor BMT for treatment of patients with high risk AML when a family match is not available.
Sierra
J
J
Fred Hutchinson Cancer Research Center, and the University of Washington, Seattle 98109-1024, USA.
Storer
B
B
Hansen
J A
JA
Martin
P J
PJ
Petersdorf
E W
EW
Woolfrey
A
A
Matthews
D
D
Sanders
J E
JE
Storb
R
R
Appelbaum
F R
FR
Anasetti
C
C
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate; D014019:Tissue Donors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014861:Washington