RESULTS OF ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR ACUTE-LEUKEMIA HAVE IMPROVED IN EUROPE WITH TIME - A REPORT OF THE ACUTE-LEUKEMIA WORKING PARTY OF THE EUROPEAN GROUP FOR BLOOD AND MARROW TRANSPLANTATION (EBMT)

To evaluate whether the results of bone marrow transplantation have im proved in Europe with time, we analyzed the outcome for 2195 patients with acute leukemia. 1405 had acute myeloid leukemia (AML) and 790 had acute lymphoblastic leukemia (ALL), and were allografted in first com plete remission between September 1979 and December 1991 with marrow f rom an HLA-identical sibling donor. We found a continuing improvement more evident since 1987 for AML and since 1986 for ALL. A substantial reduction in the 3 years transplant related mortality (TRM): 26 vs 39% for AML (P=10(-4)), and 25 vs 39% for ALL (P=10(-4)), has resulted in an increase of the 5-year actuarial leukemia-free survival (LFS). 57 vs 45% for AML (P < 10(-4)) and 54 vs 45% (P = 10(-4)) for ALL. Four i mportant changes have occurred. (1) Graft-versus-host disease (GVHD) p revention has involved an increased use of cyclosporin A (CsA) alone a nd subsequently its use in combination with methotrexate: this was ass ociated with lower TRM both in AML and ALL; (2) Use of total body irra diation as pretransplant regimen has decreased; (3) a shorter interval from remission to BMT is more common; (4) an older population of pati ents has undergone BMT. Multivariate analyses were performed separatel y in AML and ALL. In AML four variables significantly influenced TRM f avorably: year of BMT (P=10(-4)), younger age at BMT (P=10(-4)), preve ntion of GVHD including CsA (P=0.008), sex match other than female don or to male recipient (P=0.002). The relapse incidence (RI) was lower i n patients with FAB M1-2-3 vs M4-5 (P=0.0004). The LFS improved by yea r of BMT (P=0.0004), younger age at BMT (P=10(-4)), prevention of GVHD including CsA (P=0.01), FAB M1-2-3 (P=0.03). In ALL, three variables were associated with a fewer TRM: year of BMT (P=10(-4)), younger age at BMT (P=10(-4)), sex combination other than female to male (P=0.008) . The LFS was better after 1986 (P=0.0004) and in younger patients (P= 10(-4)). However a better outcome after 1986/87 was observed in patien ts receiving the same GVHD prophylaxis: therefore, other unidentified factors resulting in better patient care have also contributed to this . The improved results of allogeneic BMT are entirely related to a red uction in TRM without loss of the antileukemic effect since relapse in cidence has not changed over the years.