ALLOGENEIC AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN AML IN FIRSTREMISSION - THE SPANISH EXPERIENCE

From 1983 to 1994 two types of trials were performed. Between 1983 and 1987 modified VAPA protocol (post-remission therapy with intensive se quential blocks for 12-16 months) was given to 40 patients from two in stitutions. CR was attained in 75% and 5-year EFS was 35%. In 1988 a p ostremission protocol based on intensification chemotherapy (two high- dose Ara C treatments combined with mitoxantrone in the first and amsa crine in the second) followed by BMT was initiated. Remission inductio n was DAE combination (1 or 2). Patients in CR or PR with HLA-compatib le donor received an allogeneic transplant (al-BMT) and those without an autologous transplant (ABMT) with ''purged'' marrow. Pre-BMT therap y was fractionated TBI and CYCLO in patients over 3 years and Busulfan + CYCLO + VP-16 in those under 3. Between April '88 and December '94, 51 patients (aged 3 months to 15 years) were enrolled, 80% attained C R, 14% were failures or partial responses and 6% died before the 30th day. During the intensification phase, 5 patients attained CR and one relapsed and died. 47 patients (45 in CR and 2 in PR) proceeded to the BMT phase. 16 patients (14 in CR and 2 in PR) received al-BMT and 31 (all in CR) ABMT. Both group characteristics were comparable. Haemopoi etic reconstitution was significantly slower in ABMT and there were si x poor implants treated with growth factors (IL-3 + GM-CSF) and untrea ted back-up marrow (in 4). Transplant-related mortality was 13 in al-B MT and 0 in ABMT. Relapse rate was higher in ABMT (7/31 vs 1/16). Esti mated EFS was 81% for patients receiving al-BMT and 80% for those with ABMT, after a median follow-up of 38 months (10-88 months). The last relapse was at 13 months posttransplant. Survival for all the series ( 51 patients) was 74% at 5 years, Conclusion: These results indicate th at intensified consolidation chemotherapy followed by al-BMT or ABMT i s a very effective treatment for AML in children. No differences in EF S were observed between al-BMT and ABMT in this series (p=0.99).