Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purging for acute myeloid leukaemia beyond first remission: a 10-year experience.
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.
Smith
B Douglas
BD
Johns Hopkins Oncology Center, Bunting-Blaustein Cancer Research Building, Rm 246, 1650 Orleans Street, Baltimore, MD 21231, USA. smithdo@jhmi.edu
Jones
Richard J
RJ
Lee
Shing M
SM
Piantadosi
Steve
S
Vala
Milada S
MS
Fuller
Don
D
Gore
Steven D
SD
Noga
Steven J
SJ
O'Donnell
Paul V
PV
Braine
Hayden
H
Vogelsang
Georgia B
GB
Fuchs
Ephraim J
EJ
Flinn
Ian W
IW
Brodsky
Robert A
RA
Ambinder
Richard F
RF
Miller
Carole B
CB
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
D003520:Cyclophosphamide; C011272:perfosfamide