T-CELL-DEPLETED ALLOGENEIC BONE-MARROW TRANSPLANTATION AS POSTREMISSION THERAPY FOR ACUTE MYELOGENOUS LEUKEMIA - FREEDOM FROM RELAPSE IN THE ABSENCE OF GRAFT-VERSUS-HOST DISEASE

Thirty-one consecutive patients with acute myelogenous leukemia (AML) in first complete remission and 8 with AML in second complete remissio n received T cell-depleted allogeneic bone marrow transplants from HLA -identical sibling donors. Patients received myeloablative cytoreducti on consisting of hyperfractionated total body irradiation, thiotepa, a nd cyclophosphamide. Those patients at risk for immune-mediated graft rejection received additional immune suppression with antithymocyte gl obulin and methylprednisolone in the early peritransplant period. Pati ents with AML who underwent allogeneic T-cell-depleted bone marrow tra nsplantations (BMT) in first or second remission have achieved respect ive disease-free survival (DFS) probabilities of 77% (median follow-up at approximately 56 months) and 50% (median follow-up at approximatel y 48 months). Ten of 31 patients transplanted in first remission were greater than or equal to 40 years old and have attained a DFS at 4 yea rs of 70%. For patients with AML transplanted in first or second remis sion, the respective cause-specific probabilities of relapse were 3.2% or 12.5%, and those of nonleukemic mortality were 19.4% or 37.5%. The re were no cases of immune-mediated graft rejection and no cases of gr ade II to IV acute graft-versus-host disease (GVHD). All survivors enj oy Karnofsky performance scores (KPS) of 100%, except 2 patients with KPS of 80% to 90%. T-cell-depleted allogeneic BMT can provide durable DFS together with an excellent performance status in the majority of p atients with de novo AML. In addition, GVHD is not an obligatory corre late of the graft-versus-leukemia benefit or freedom from relapse affo rded by allogeneic BMT administered as postremission therapy for AML. This study provides a basis for prospective comparison with other post remission therapies considered standard in the management of patients with this disease. (C) 1998 by The American Society of Hematology.