ARE PATIENTS WITH ACUTE-LEUKEMIA, ALIVE AND WELL 2 YEARS POST BONE-MARROW TRANSPLANTATION CURED - A EUROPEAN SURVEY

We investigated the occurrence of late events (beyond 2 years) in pati ents with acute leukaemia who received an allogeneic (BMT) (n=1059), o r an autologous bone marrow transplantation (ABMT) (n=656) in Europe d uring the period from January 1979 to December 1990. Patients with no recurrence of leukaemia at 2 years had overall 82% chance of being ali ve in complete remission at 9 years following transplantation regardle ss of the nature of the leukaemia, the status at transplant, and the t ype of transplant. The incidence of late relapses continuously decreas ed with time. The latest relapses in acute myelogenous leukaemia (AML) were observed following BMT at 6.6 years in a patient transplanted in first remission (CR1) and at 3.7 years in a patient transplanted in s econd remission (CR2), and following ABMT at 6 years and 5.1 years res pectively. The latest relapses in acute lymphoblastic leukaemia (ALL) were observed following BMT at 4 years in a patient transplanted in fi rst remission (CRI) and at 6.8 years in a patient transplanted in seco nd remission (CR2), and following ABMT at 5.3 years and 4.5 years resp ectively. Several factors predictive for late relapse or death were id entified. Patients allografted experienced a lower frequency of late r elapse than patients autografted. Of the numerous other prognostic fac tors studied, female sex in AML, the use of total body irradiation (TB I) in ALL and status in CR1, rather than CR2-3, for both ALL and AML a llografted were correlated with a lower relapse incidence. The use of TBI in ALL was also associated with a better LFS and survival. The abs ence of acute graft-versus-host disease (GVHD) in allografted AML corr elated with better LFS and better survival, but had no influence on th e relapse incidence. This study indicates that patients alive and well at 2 years post transplant have a very high probability of being cure d, but the possibility of late relapse still remains.