title: Partially mismatched related donor bone marrow transplantation as salvage for patients with AML who failed autologous stem cell transplant.
abstract: Treatment options for patients who relapse are limited and the outcome is dismal. Between August 1993 and January 1999, 17 patients, median age 26 (4-44) years, underwent T cell depleted bone marrow transplant from partially mismatched related donors (PMRD), as a salvage for AML relapsing after an autograft. The median time from auto-transplant to relapse was 7 months (1.5-24) and the interval between transplants was 10 months (3-30). All patients had active leukemia at time of transplant. Donors were siblings (n = 8), parents (n = 2), daughters (n = 4) and others (n = 3), and 82% were > or = 2 major HLA antigen mismatched with the recipient. The conditioning therapy included total body irradiation in 14 patients and was busulfan-based in three. Graft-versus-host disease (GVHD) prophylaxis consisted of partial T cell depletion along with post-transplant immunosuppression. Median day to engraftment was 16 days (12-20). Acute GVHD was seen in six patients, and chronic GVHD in four of 13 surviving beyond 100 days. Ten patients died of non-relapse causes, at 1-588 (median 77) days. Two patients relapsed at 3 and 4 months. Five patients (29%) are surviving leukemia-free 42-84 months post transplant (median 68 months). A short interval between transplants was predictive of early relapse but not mortality. Age <18 and <2 organ toxicities were marginally predictive of better survival. We conclude that BMT from PMRD is a reasonable option for patients with refractory AML post autograft.
authors.affiliation: Division of Transplantation Medicine, South Carolina Cancer Center Columbia, SC, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Godder
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: K Y
authors.initials: KY
authors.lastname: Chiang
authors.forename: S
authors.initials: S
authors.lastname: Adams
authors.forename: F
authors.initials: F
authors.lastname: van Rhee
authors.forename: S
authors.initials: S
authors.lastname: Singhal
authors.forename: K
authors.initials: K
authors.lastname: Higgins-Smith
authors.forename: W
authors.initials: W
authors.lastname: O'Neal
authors.forename: S
authors.initials: S
authors.lastname: DeRienzo
authors.forename: J P
authors.initials: JP
authors.lastname: Henslee-Downey
authors.forename: J
authors.initials: J
authors.lastname: Metha
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D013534:Survival; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D017211:Treatment Failure