FEASIBILITY AND RESULTS OF BONE-MARROW TRANSPLANTATION AFTER REMISSION INDUCTION AND INTENSIFICATION CHEMOTHERAPY IN DE-NOVO ACUTE MYELOID-LEUKEMIA

Purpose: To evaluate prospectively the feasibility and results of bone marrow transplantation (BMT) after induction and intensification chem otherapy (CT) in patients with de novo acute myeloid leukemia (AML). P atients and Methods: A total of 159 patients less than 51 years of age were treated. Induction CT consisted of daunorubicin 60 mg/m(2) for 3 days, cytarabine (ARA-C) 100 mg/m(2) for 7 days, and etoposide 100 mg /m(2) for 3 days. The first intensification therapy included mitoxantr one 10 mg/m(2) for 3 days and ARA-C 1.2 g/m(2) every 12 hours for 4 da ys. Amsacrine (100 or 150 mg/m(2) for 3 days) and ARA-C (1.2 g/m(2) ev ery 12 hours for 2 or 4 days) were given as the second intensification therapy. Depending on the availability of a human leukocyte antigen ( HLA)-identical sibling, the intention of treatment after CT wets allog eneic BMT (allo-BMT) or autologous BMT (ABMT). Results: Complete remis sion (CR) was obtained in 120 patients (75%) and partial remission (PR ) in 11 (7%), while 15 patients (10%) were refractory and 13 (8%) died during induction. There was a trend for better leukemia-free survival (LFS) at 4 years for patients assigned to the ABMT group (50% +/- 6%) compared with the allo-BMT group (31% +/- 7%) (P = .08). This differe nce in LFS reached statistical significance when considering only tran splanted patients (63% +/- 3% at 4 years after ABMT and 38% +/- 11 aft er allo-BMT, P = .02). The favorable results in patients who received ABMT (no toxic deaths and 37% +/- 7% probability of relapse at 4 years ) contrast with the poor outcome of allografted patients (11 patients with transplant-related mortality). Conclusion: Our study reflects the difficulties in the completion of a therapeutic strategy that include s BMT and suggests that intensification before BMT may be useful in th e setting of ABMT, but this approach was associated with a high mortal ity rate in allo-BMT patients. (C) 1996 by American Society of Clinica l Oncology.