AUTOLOGOUS BONE-MARROW TRANSPLANT IN ACUT E MYELOBLASTIC-LEUKEMIA IN FIRST COMPLETE REMISSION - CLINICAL-RESULTS IN 41 PATIENTS

BACKGROUND: A single-center experience using autologous bone marrow tr ansplantation (ABMT) as postremission therapy for acute myeloid leukem ia (AML) in first complete remission (CR1) in 41 patients is analyzed. PATIENTS AND METHODS: From July 1986 to March 1994, 41 patients with AML in CR1 underwent an ABMT, Source of hematopoietic stem cells was b one marrow in all cases. In eleven patients the marrow was purged with mafosfamide (ASTA-Z 7654). Median age was 31 years (17-59) and median time from CR to ABMT was 7 months (3-27), Busulfan (16 mg/kg) and cyc lophosphamide (120 mg/kg) was employed as conditioning regimen in 36 p atients. The rest 5 patients were prepared with cyclophosphamide (120 mg/kg) and fractioned total body irradiation (12Gy). Eleven patients r eceived G-CSF after AMBT because of an absolute neutrophil coung lower than 0.5 x 10(9) on day +30. Survival analysis was performed accordin g to the methods of Kaplan and Meier and comparison between groups use d the log-rank test. RESULTS: With a median follow-up of 26 months (12 -75) 21 patients remain alive in CR. Disease-free survival (DFS) at fi ve years was 40% (95% CI: 25-55%), Transplant-related mortality, mainl y for infection and hemorrhage, occurred in 6/41 patients (16%). Leuke mia relapse was the main cause of treatment failure: 14/35 (40%). Prob ability of DFS and relapse was similar for those patients with purged ABMT on unpurged ABMT 45 +/- 23% vs 38 +/- 16% and 37 +/- 14% vs 54 +/ - 22% respectively. A significantly longer enfraftment time for neutro phils (> 0.5 x 10(9)) and platelets (> 20 x 10(9)) was observed in tho se patients who received a bone marrow treated with mafosfamide compar ed with the unpurged group (54 vs 29 days for neutrophils and 102 vs 5 8 for platelets respectively) (p < 0.05). CONCLUSIONS: ABMT is a feasi ble treatment for AML in CR1. Using bone marrow as hematopoietic stem cell support we observed that delayed engraftment was a common finding among AML patients, specially when the marrow was treatment with mafo sfamide. Leukemia relapse remains as the main cause of treatment failu re for ABMT.