Long-term outcome of adult acute leukemia patients who are alive and well 2 years after autologous blood or marrow transplantation

We studied the long-term outcome of 87 adults with acute leukemia (age 15-5 9 years at transplant, median 27; 44 myeloid, 42 lymphoblastic, one bipheno typic) who were alive in continuous remission 2 years after a marrow (n = 7 4) or blood stem cell (n = 13) autograft, Nine relapsed 25-50 months (media n 38) after transplantation, Five relapses were straightforward with no kar yotypic or morphologic evolution of the original disease, Four recurrences were unusual, with development of myelodysplasia (n = 3) or myeloproliferat ive disease (n = 1), Five patients died of relapsed disease and four are st ill alive, Two patients died of complications related to the transplant, an d one of ischemic heart disease, Seventy-nine patients (91%) are alive in r emission 24-149 months (median 67) after transplantation (75 in continuous remission and four after further therapy) with Karnofsky scores of 80-100% (median 100%). The 8-year probabilities of survival, toxic death, and relap se (from the 2-year mark) are 89%, 3% and 12%, Eleven (12%) survivors had c reatinine levels of >110 mu mol/l tone more than double), and 14 (16%) had bilirubin levels of >17 mmol/l tone more than double) at the last follow-up , None of the following factors was found to be predictive for survival, no n-relapse death, or relapse from the 2-year mark in multivariate analysis: age, sex, type of leukemia, disease stage, diagnosis, conditioning, origin of cells, and nucleated cell dose, We conclude that adult patients with acu te leukemia who are alive and well 2 years following an autograft have a hi gh probability of being cured, and the incidence of long-term liver and kid ney dysfunction measured by serum bilirubin and creatinine is low.