LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR ACUTE MYELOID-LEUKEMIA IN FIRST COMPLETE REMISSION AFTER CYCLOPHOSPHAMIDE-TOTAL BODY IRRADIATION AND CYCLOSPORINE

Eighty-five patients (median age 28 years) with acute myeloid leukemia (AML) in first remission underwent allogeneic bone marrow transplanta tion (BMT) from HLA-identical siblings between 1978 and 1987 after cyc lophosphamide and single-fraction total body irradiation with cyclospo rine for graft-versus-host disease (GVHD) prophylaxis. The actuarial p robabilities of development of acute and chronic GVHD were 57% and 47% , respectively. Twenty-six patients died of transplant-related complic ations at a median of 3.5 months, and two of unrelated causes. Sevente en patients relapsed at a median of 6.5 months. Forty patients were al ive and well at 74-197 months (median 157) after BMT; seven (18%) with limited chronic GVHD requiring therapy, The actuarial 10-year probabi lities of transplant-related death, relapse, and disease-free survival were 33%, 25% and 48% respectively. In multivariate analysis, infusio n of a lower cell dose, development of GVHD, and age >35 years were as sociated with increased transplant-related mortality, donor-recipient ABO incompatibility with a lower relapse rate, and age >35 Sears and a lower cell dose with poorer disease-free survival. We conclude that w ith long-term followup, allografting in AML after cyclophosphamide-TBI and cyclosporine has resulted in disease-free survival that is compar able to most currently reported series. Patients who are alive and wel l 3-4 years after BMT have excellent prospects of long-term survival.