BONE-MARROW TRANSPLANTATION IN 63 ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC-LEUKEMIA IN FIRST COMPLETE REMISSION

Over a 10 year period, we transplanted 63 patients with acute lymphobl astic leukaemia (ALL) who had achieved first complete remission (CR). All were > 15 years old and 45 (71%) had at least one poor prognostic factor. Twenty-nine patients with a suitable sibling underwent autolog ous bone marrow transplantation (BMT). Beginning in 1984, patients wit hout a donor received an allogeneic BMT (34 patients). Preparation con sisted of cyclophosphamide (CY)/TBI (78%) or melphalan (Mel)/TBI (22%) ; marrow was treated in vitro in 31 patients (allogeneic: 7; autologou s: 24). Kaplan-Meier estimates of the probability at 6 years of relaps e, survival and DFS were 41% (allogeneic: 10%, autologous: 65%, p < 0. 05), 44% (allogeneic: 62%, autologous: 26%, p = NS) and 42% (allogenei c: 62%, autologous: 27%, p < 0.06), respectively. This report confirms that allogeneic BMT permits long-term remissions giving high levels o f survival when performed shortly after entering first CR while autolo gous BMT, when performed in the same setting, is less successful at pr eventing relapse. This study also confirms the high sensitivity of ALL to the graft-versus-leukemia effect provided by allogeneic BMT. Chemo radiotherapy dose intensification delivered at autologous BMT is not s ufficient to prevent relapses. Autologous BMT must therefore be augmen ted by other approaches of which immunotherapy may be one.