5-YEAR LEUKEMIA-FREE SURVIVAL OF 72-PERCENT AND 77-PERCENT FOR EARLY-STAGE ACUTE AND CHRONIC MYELOID-LEUKEMIA TREATED BY HLA-IDENTICAL SIBLING BONE-MARROW TRANSPLANTATION

Background: HLA-identical sibling bone marrow transplantation is an ac cepted treatment for patients with acute myeloid leukaemia (AML) and c hronic myeloid leukaemia (CML). We have recently reported improving re sults in HLA-identical sibling transplant over the ten year period 198 1-1990. In this report we described the outcome in patients transplant ed at St Vincent's Hospital, Sydney between 1989 and 1993. Aims: To de termine the leukaemia-free survival, transplant-related mortality rate , and relapse rate for patients with AML or CML given HLA-identical si bling marrow transplants between 1989 and 1993. Methods: Sixty-two pat ients with AML or CML received high dose busulphan/cyclophosphamide ch emotherapy followed by infusion of T replete, HLA-identical sibling bo ne marrow Cyclosporin/short methotrexate was utilised as prophylaxis f or graft-versus-host disease, ganciclovir as prophylaxis for cytomegal ovirus disease and cotrimoxazole as prophylaxis for Pneumocystis carin ii pneumonia. Low dose intravenous heparin was used as prophylaxis for hepatic veno-occlusive disease. Results: The five year disease-free s urvival for patients with AML transplanted in first complete remission was 72% and for those with CML transplanted in first chronic phase wa s 77%. The relapse rate for AML transplanted in first complete remissi on was 15% and for CML in first chronic phase 0%. The transplant-relat ed mortality for AML transplanted in first complete remission was 16% and for CML transplanted in first chronic phase 23%. In contrast, the disease-free survival, relapse rate and transplant-related mortality f or patients with AML transplanted outside first complete remission and for CML transplanted beyond first chronic phase was 17%, 57% and 57% respectively. Conclusions: The outcome for patients transplanted for e arly AML or early CML continues to improve and exceeds that obtainable by conventional therapy. The salvage rate is so low for patients tran splanted in later stages of AML or CML that all patients less than 55 years of age with these diseases, who have a HLA-identical sibling don or, should be offered bone marrow transplantation early in their disea se course.