ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR ACUTE MYELOID-LEUKEMIA IN FIRST COMPLETE REMISSION - THE EFFECT OF FAB CLASSIFICATION AND GVHD PROPHYLAXIS

Ninety-one patients with de novo acute myeloid leukemia (AML) in first complete remission (CR) undergoing an HLA-identical sibling BMT and w ith a minimum follow-up of 12 months were analyzed for disease-related and transplant-related variables predicting survival and relapse. The overall actuarial 5 year survival is 53% and the relapse rate 29%, wi th a medium follow-up for surviving patients of 1552 days (range 365-4 094 days). In univariate analysis the following variables were found t o be associated with an increased risk of failure: high-dose cyclospor in (CsA), M4-M6 FAB subtype and a long interval (greater than or equal to 180 days) between diagnosis and BMT. Other disease-related variabl es at presentation were not significant, including WBC count > 50 X 10 (9)/1, marrow blasts < 70%, time to enter remission > 40 days and > 2 courses to enter remission. Survival was 58% vs 43% for M1-M3 vs M4-M6 FAB subtypes (p = 0.03) and 71% vs 42% for low-dose vs high-dose CsA (p = 0.01). A multivariate analysis was then run separately on surviva l, relapse and transplant related mortality (TRM). Survival was negati vely influenced by M4-M6 FAB subtypes (p = 0.003) and in females (p = 0.04). Transplant-related mortality was higher in FAB M4-M6 patients ( p = 0.01) and patients grafted late after diagnosis (p = 0.03). In gra ft immunosuppression has a positive effect on survival and relapse, (2 ) patients with M4-M6 AML hav ea mortality, and (3) that late transpla nts (> 6 months from diagnosis) also seem to have a worse prognosis. T hese data suggest that results of allogeneic BMT in AML can be improve d by modifications of the transplant protocols.