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One hundred twenty-five adult patients with primary acute leukemia
autografted with marrow purged by mafosfamide: a 10-year single institution
experience
JP Laporte, L Douay, M Lopez, M Labopin, JP Jouet, S Lesage, J Stachowiak, L Fouillard, F Isnard and MP Noel-Walter
Bone Marrow Transplant Unit, Hopital St. Antoine, Paris, France.
A total of 125 acute leukemia adult patients were autografted with bone
marrow (BM) purged by mafosfamide (ASTA Z) during the period of January
1983 to January 1993. The median follow-up period was 64 months (range, 3
to 126). There were 84 acute myeloblastic leukemias (AMLs) and 41 acute
lymphoblastic leukemias (ALLs). At time of autologous BM transplantation
(ABMT); 64 AMLs were in first complete remission (CR1), and 20 were in
second CR (CR2); 35 ALL were in CR1, and 6 were in CR2. The median age of
the patients was 33 years (range, 16 to 55). The median interval between
achieving CR and autografting was 5 months (range, 1.3 to 23). The
pretransplant regimen consisted of cyclophosphamide (120 mg/kg) and total
body irradiation. All patients were grafted with autologous BM treated in
vitro with mafosfamide used at levels individually adjusted in 95 patients
and at a standard dose in 30 patients. The initial richness in
granulomacrophagic progenitors (CFU-GM) of the harvested BMs was 5.16 x
10(4) CFU-GM/kg (range, 0.55 to 33). After mafosfamide purging, the
residual CFU-GM number was 0.021 x 10(4)/kg (range, 0 to 1.78). The
probability of successful engraftment was significantly higher and the time
to engraftment was significantly shorter in ALL. Of 33 patients grafted
with BM containing no residual CFU-GM, those with AML (n = 22) had platelet
recoveries that were significantly longer than those for AML patients
receiving BM with residual CFU-GM. At 8 years, patients autografted in CR1
for AML and ALL had a leukemia-free survival (LFS) of 58% and 56%,
respectively, with a relapse incidence (RI) of 25% and 37%, respectively.
Patients autografted in CR2 for AML had an LFS of 34% and an RI of 48% at 5
years. The incidence of late relapses was significantly higher in ALLs. By
multivariate analysis, four factors were found to influence favorably
engraftment in addition to a diagnosis of ALL, a younger age, ABMT
performed in CR1, the adjusted dose technique of purging, and a shorter
interval from CR to ABMT. Two factors were correlated with a better
outcome. (1) The LFS was significantly higher and the transplant-related
mortality significantly lower in patients who received richer BM. (2) The
RI was significantly lower in patients autografted within 150 days from CR.
Our results reinforce the view that ABMT is one approach to improve the
outcome of adult patients with acute leukemia.(ABSTRACT TRUNCATED AT 250
WORDS)
Volume 84,
Issue 11,
pp. 3810-3818,
12/01/1994
Copyright © 1994 by The American Society of Hematology
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