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Allogeneic bone marrow transplantation for acute nonlymphocytic leukemia in
first remission
PB McGlave, RJ Haake, BC Bostrom, R Brunning, DD Hurd, TH Kim, ME Nesbit, GM Vercellotti, D Weisdorf and WG Woods
Department of Medicine, University of Minnesota, Minneapolis.
Seventy-three patients with acute nonlymphocytic leukemia in first complete
remission (CR) have received allogeneic bone marrow transplantation (BMT)
with non-T-lymphocyte-depleted marrow obtained from matched sibling donors.
The first 36 patients received a preparative regimen consisting of
cyclophosphamide, 60 mg/kg/d (days -6 and -5), and 750 cGy single-dose
total-body irradiation (TBI) (day -1). Subsequently, 37 patients received
cyclophosphamide 60 mg/kg/d (days -6 and -5), and 165 cGy fractionated TBI
administered twice daily for a total dose of 1,320 cGy (days -4, -3, -2,
and -1). Survivors have been followed from 9 to 124 months (median, 40
months). The 61% (95% confidence interval [CI], 45% to 77%) projected
disease-free survival (DFS) of 41 children less than 18 years old does not
differ significantly from the 62% (95% CI, 49% to 73%) projected DFS of 32
adults at 84 months (P = .89). Similarly, the 15% (95% CI, 1% to 29%)
projected relapse rate seen in children does not differ from the 9% (95%
CI, 0% to 21%) seen in adults (P = .69). Multivariate Cox regression
analysis of presenting features demonstrates that a presenting WBC count
greater than 20,000/m3 is associated with decreased DFS (P = .01). When
compared with other French-American- British (FAB) subtypes, presentation
with FAB M4 or M5 morphology is significantly associated with relapse in
multivariate analysis (P = .014). Other presenting features such as
preparation with single-dose or fractionated TBI, interval from diagnosis
to CR or CR to BMT, donor or recipient sex, and donor or recipient
cytomegalovirus serology do not correlate independently with either DFS or
relapse. When included in the stepwise multivariate analysis of presenting
patient features, two posttransplant events, development of grades 2 to 4
acute graft-v- host disease (GVHD) (P less than .03) and development of
interstitial pneumonitis (P less than .001), also correlate independently
with poor DFS. Allogeneic BMT provides equivalent, prolonged DFS in both
children and young adults when performed in first CR and should be
considered the therapy of choice for all first CR patients under 45 years
of age with a suitable donor. Continued efforts to prevent and treat acute
GVHD and pneumonitis as well as efforts designed to prevent relapse in
patients presenting with FAB M4 and M5 morphology should further improve
outcome.
Volume 72,
Issue 5,
pp. 1512-1517,
11/01/1988
Copyright © 1988 by The American Society of Hematology
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