HIGH-INCIDENCE OF EXTRAMEDULLARY RELAPSE OF AML AFTER BUSULFAN CYCLOPHOSPHAMIDE CONDITIONING AND ALLOGENEIC STEM-CELL TRANSPLANTATION/

While allogeneic stem cell transplantation (SCT) is curative for a sig nificant number of patients with AML, relapse of disease within the bo ne marrow and/or extramedullary (EM) sites following high-dose therapy continues to limit the success of this treatment. Between October 198 5 and December 1996, 81 adults underwent allogeneic SCT for de novo AM L at our centre, Forty-two patients remain alive and free of leukaemia with a median follow-up of 50 months. The 5-year actuarial event-free survivals (EFS) for all patients and for those undergoing SCT in CR1 or with advanced disease were 46% (95% confidence interval (CI) 34-58% ), 63% (CI 46-76%), and 19% (CI 7-36%), respectively. Twenty-two patie nts relapsed at a median of 8 (range 1.6-54.5) months with the actuari al risk of relapse for all, CR1 and advanced disease patients being 38 %, (CI 27-52%), 23% (CI 13-40%) and 68% (CI 46-88%), respectively. Ten patients relapsed at EM sites; six of these (27% of relapses) had an isolated EM relapse at a median of 31 (range 8.5-54) months. Three of the patients with isolated ER I relapse survived greater than or equal to 24 months following relapse and two patients remain disease-free a t 29+ and 33+ months. BuCy conditioning followed by allogeneic SCT in AML results in satisfactory EFS although there is a significant risk o f late isolated Ehl relapse.