title: Long-term outcome after intensive therapy with etoposide, melphalan, total body irradiation and autotransplant for acute myeloid leukemia.
abstract: Intensive therapy and autologous blood and marrow transplantation (ABMT) is an established post-remission treatment for acute myeloid leukemia (AML), although its exact role remains controversial and few data are available regarding longer-term outcomes. We examined the long-term outcome of patients with AML transplanted at a single center using uniform intensive therapy consisting of etoposide, melphalan and TBI. In all, 145 patients with AML underwent ABMT: 117 in first remission, 21 in second remission and seven beyond second remission. EFS and OS were significantly predicted by remission status (P<0.0001). For transplantation in first remission, 8 year EFS and OS were 55% (95% CI, 44-64%) and 62% (95% CI, 50-72%), respectively. By multivariate analysis, only age (P=0.04) and cytogenetic risk group (P=0.006) influenced OS. For patients transplanted in second remission, 8 year EFS and OS were 30% (95% CI, 9-55%) and 36% (95% CI, 13-60%), respectively. No pre-transplant variables significantly predicted outcome. None of the seven patients who underwent ABMT beyond second remission or in early relapse were long-term survivors. ABMT can provide long-term antileukemic control for patients with AML in first remission. For patients in second remission approximately 30% can achieve cure with ABMT, and this option may be preferable to alternate donor allogeneic stem cell transplantation.
authors.affiliation: Department of Hematology, University of Toronto Autologous Blood and Marrow Transplant Program, Princess Margaret Hospital/Ontario Cancer Institute, Toronto, ON, Canada. p.mollee@uq.net.au
authors.forename: P
authors.initials: P
authors.lastname: Mollee
authors.forename: V
authors.initials: V
authors.lastname: Gupta
authors.forename: K
authors.initials: K
authors.lastname: Song
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.forename: N
authors.initials: N
authors.lastname: Califaretti
authors.forename: R
authors.initials: R
authors.lastname: Tsang
authors.forename: M
authors.initials: M
authors.lastname: Crump
authors.forename: A
authors.initials: A
authors.lastname: Keating
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003625:Data Collection; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007951:Leukemia, Myeloid / Q000401:mortality / Q000628:therapy*; D008137:Longitudinal Studies; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D005047:Etoposide; D008558:Melphalan