ALLOGENEIC AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR ACUTE NONLYMPHOBLASTIC LEUKEMIA

Bone marrow transplantation (BMT) has had an increasing role in the tr eatment of acute nonlymphoblastic leukaemia (ANLL). A review of patien ts transplanted between May 1975 and August 1991 was undertaken in ord er to evaluate problems and outcome, and examine the role of both auto logous and allogeneic BMT at various stages in the treatment of ANLL. Forty-seven patients received either an allogeneic (n = 24) if a suita ble donor was identified or autologous (n = 23) BMT if there was no al logeneic donor. Conditioning therapy consisted of total body irradiati on (TBI) and cyclophosphamide (n = 14) or busulfan and cyclophosphamid e (n = 33) with or without melphalan. Graft-versus-host disease preven tion was with methotrexate (n = 9), methotrexate and cyclosporin (n = 1 0) or T cell depletion (n = 5). Minimum follow-up for surviving pati ents was 24 months (median 65 months). For patients transplanted in fi rst remission there was a 0% and 9+/-6% transplant-related mortality, a 37+/-11% and 33+/-12% relapse risk and a 63+/-11% and 63+/-12% event -free survival for autologous and allogeneic BMT, respectively. In sec ond remission, there was a 14% mortality, 50+/-20% relapse risk and 43 +/-19% event-free survival for allogeneic BMT No patient transplanted in relapse survived. In patients who survived greater than 24 months, late side effects were noted in all 8 (100%) patients given TBI and in 2 of 19 (10.5%) given busulfan. These data indicate that both allogen eic and autologous BMT are associated with significant event-free surv ival when used both as initial therapy after complete remission has be en achieved with conventional chemotherapy or in second remission. All ogeneic and autologous BMT would appear to be similarly effective.