Partially mismatched related donor bone marrow transplantation as salvage for patients with AML who failed autologous stem cell transplant.
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.
Godder
K T
KT
Division of Transplantation Medicine, South Carolina Cancer Center Columbia, SC, USA.
Mehta
J
J
Chiang
K Y
KY
Adams
S
S
van Rhee
F
F
Singhal
S
S
Higgins-Smith
K
K
O'Neal
W
W
DeRienzo
S
S
Henslee-Downey
J P
JP
Metha
J
J
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