AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR FIRST REMISSION ACUTE MYELOBLASTIC-LEUKEMIA IN PATIENTS OLDER THAN 50 YEARS - A RETROSPECTIVE ANALYSIS OF THE EUROPEAN-BONE-MARROW-TRANSPLANT-GROUP

High-dose chemotherapy, with or without radiotherapy, followed by auto logous stem-cell rescue is used increasingly for the intensification o f first remission in acute myeloblastic leukemia (AML). However, these treatments have been limited to young patients due to the increased r isks of regimen-related toxicities and mortality with age. Several inv estigators have recently published the upper age limit for autologous bone marrow transplant (ABMT) in AML because of encouraging results. T he results of ABMT for AML were studied in 111 patients greater than o r equal to 50 years of age intensified in first remission. Median age at transplant was 53 years (range, 50 to 63 years). Fifty patients wer e conditioned with total body irradiation and 61 with polychemotherapy : 23 with busulfancyclophosphamide, 11 with the University College Hos pital (UGH; London, UK) regimen, 6 with BAVC, and 21 with various othe r treatments. Marrow was purged in only 11 cases. Results were compare d with 786 ABMTs performed for AML in patients between 16 and 49 years of age (median, 35 years). For AML in first remission, the probabilit y of leukemia-free survival (LFS) at 4 years was 34% +/- 5% for patien ts aged 50 years or more and 43% +/- 2% for patients less than 50 year s of age (P = .004), with a survival probability of 35% +/- 6% and 48% +/- 2%, respectively (P = .004). The probability of relapse was not s ignificantly different between the two groups (52% +/- 7% v 50% +/- 2% ), but transplant-related mortality was significantly higher in the ol der age group (28% +/- 5% v 14% +/- 2%; P < .0001) and mainly due to i nfectious complications. In a multivariate analysis, age less than 50 years was a favorable risk factor for LFS, treatment-related mortality (TRM), and survival but not for relapse incidence. These data suggest that ABMT should be considered in older AML patients. (C) 1995 by The American Society of Hematology.