title: Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purging for acute myeloid leukaemia beyond first remission: a 10-year experience.
abstract: Between January 1987 and January 1997, 69 eligible patients with acute myeloid leukaemia (AML) in either second (CR2) or third (CR3) complete remission (CR2 = 60, CR3 = 9) underwent 4-hydroperoxycyclophosphamide-purged autologous bone marrow transplantation (BMT) at the Johns Hopkins Oncology Center. The patients' median age was 27 years (range 1-62) and all received busulphan and cyclophosphamide as their preparative regimen. The probability of event-free survival (EFS) at 5 years was 30% [95% Confidence Interval (CI): 19-42%] for CR2 patients and 22% (3-51%) for those in CR3, with a median follow up of 8 years in the surviving group. The median time to an absolute neutrophil count of 0.5 x 109/l was 45 d (range 20-185). Relapse was the major cause of failure with a relapse rate of 55% in CR2 and 44% in CR3, while the non-relapse, transplant-related mortality rate was 15% in CR2 and 33% in CR3. In univariate analysis, patient age, cytogenetics, white blood cell count at presentation, CR1 duration and the sensitivity of clonogeneic leukaemia (CFU-L) in the graft to 4HC were all prognostic for EFS. Using each of these significant variables in multivariate modelling, patient age and sensitivity of CFU-L to 4HC were determined to be predictors of EFS. 4HC-purged autologous BMT produced results similar to allogeneic BMT for AML patients beyond first remission.
authors.affiliation: Johns Hopkins Oncology Center, Bunting-Blaustein Cancer Research Building, Rm 246, 1650 Orleans Street, Baltimore, MD 21231, USA. smithdo@jhmi.edu
authors.forename: B Douglas
authors.initials: BD
authors.lastname: Smith
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jones
authors.forename: Shing M
authors.initials: SM
authors.lastname: Lee
authors.forename: Steve
authors.initials: S
authors.lastname: Piantadosi
authors.forename: Milada S
authors.initials: MS
authors.lastname: Vala
authors.forename: Don
authors.initials: D
authors.lastname: Fuller
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Noga
authors.forename: Paul V
authors.initials: PV
authors.lastname: O'Donnell
authors.forename: Hayden
authors.initials: H
authors.lastname: Braine
authors.forename: Georgia B
authors.initials: GB
authors.lastname: Vogelsang
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Fuchs
authors.forename: Ian W
authors.initials: IW
authors.lastname: Flinn
authors.forename: Robert A
authors.initials: RA
authors.lastname: Brodsky
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ambinder
authors.forename: Carole B
authors.initials: CB
authors.lastname: Miller
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007951:Leukemia, Myeloid / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D014182:Transplantation, Autologous
chemical_list: D003520:Cyclophosphamide; C011272:perfosfamide