title: Unrelated donor bone marrow transplantation using a chemotherapy-only preparative regimen for adults with high-risk acute myelogenous leukemia.
abstract: Limited data are available for adults undergoing unrelated donor (URD) BMT for AML using chemotherapy-only preparative regimens. Previous studies incorporated irradiation, included adults and children, and excluded secondary leukemia. Herein we report long-term outcomes for adults with poor-prognostic AML receiving a novel regimen of busulfan (16 mg/kg), cytarabine (8,000 mg/m(2)), and cyclophosphamide (120 mg/kg) (BAC), followed by URD BMT. From June 1995 through October 2001, 45 adults were enrolled. Adverse features included unfavorable cytogenetics (49%), secondary AML (47%), leukemia at transplant (42%), and extramedullary disease (16%). At time of BMT, 23 were in remission (12 CR1) while 22 had leukemia. Four (9%) died early. Acute and chronic GVHD rates were 44 and 67%, respectively. Seventeen (38%) were disease-free 52 months post-BMT; 13 were leukemia-free (eight CR1) at transplant. Eleven relapsed. Three-year DFS and OS were 42 and 46%, respectively. DFS and OS were longer, and relapses less, for those in CR at time of BMT. Secondary leukemia, cytogenetics, cell dose, and GVHD did not influence outcome. In poor-risk AML, BAC provided cytoreduction comparable to reported TBI-containing regimens, when administered for URD BMT. With decreasing treatment-related mortality, it is justified to proceed early to URD BMT for patients with poor prognostic features.
authors.affiliation: Department of Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA. ayashl@karmanos.org
authors.forename: Lois J
authors.initials: LJ
authors.lastname: Ayash
authors.forename: Voravit
authors.initials: V
authors.lastname: Ratanatharathorn
authors.forename: Thomas
authors.initials: T
authors.lastname: Braun
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Silver
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reynolds
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Uberti
mesh_terms: D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016026:Bone Marrow Transplantation / Q000401:mortality; D002908:Chronic Disease; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005176:Factor XIII / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage / Q000009:adverse effects; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D004317:Doxorubicin; D005340:Fibrinogen; D005176:Factor XIII; D013917:Thrombin