RETROSPECTIVE EVALUATION OF AUTOLOGOUS BONE-MARROW TRANSPLANTATION VSALLOGENEIC BONE-MARROW TRANSPLANTATION FROM AN HLA IDENTICAL RELATED DONOR IN ACUTE MYELOCYTIC-LEUKEMIA - A STUDY OF THE ERATIVE-GROUP-FOR-BLOOD-AND-MARROW-TRANSPLANTATION (EBMT)

We analyzed retrospectively data from 1696 patients with AML transplan ted in Europe from January 1987 to December 1992 and reported to the a cute leukemia EBMT registry. Groups of patients were analyzed accordin g to age (adults and children) and status at transplant (first remissi on = CR1; second remission CR2). (1) 1114 adult patients were transpla nted in CR1; 516 received an allograft; 598 received an autograft. Fol lowing alloBMT, the transplant-related mortality (TRM) was significant ly higher (27 vs 13%, P < 10(-4)), the relapse incidence (RI) lower (2 5 vs 52%, P < 10(-4)) and the leukemia-free survival (LFS) better (55 vs 42%, P = 0.006). Favorable prognostic factors for alloBMT were a FA B type other than M4-M5, a donor-recipient combination excluding a fem ale donor to a male recipient, and a younger age. Favorable prognostic factors for ABMT were a younger age of the patients at time of transp lant, the AML3 FAB type, and a longer interval from CR1 to ABMT. (2) 2 88 adult patients were transplanted in CR2: 98 received an allograft; 190 received an autograft. The TRM was higher following allogeneic BMT (32 vs 20%, P = 0.02) and the RI lower (42 vs 63%, P = 0.001). The LF S was not significantly different (alloBMT: 39%; ABMT: 30%, P = 0.22). (3) 242 children were transplanted in CR1; 129 received an allograft; 113 received an autograft. Following alloBMT, the RI was lower (25 5 vs 48 + 6%, P < 10(-4)), and the LFS better (68 vs 47%, P = 0.002), The use of TBI was a favorable prognostic factor in allografted patien ts with a lower RI and a better LFS. (4) The number of children transp lanted in CR2 was too small for a comparative analysis. These results confirm that both allogeneic and autologous BMT are suitable curative approaches for AML, They favor the use of an HLA identical related all ogeneic transplant when available, especially in younger patients, ove r ABMT with unpurged marrow. The role of purging in ABMT could not be addressed in this study.