Autologous Bone Marrow Transplantation in Acute Myelocytic Leukemia in Europe: The Role of Marrow Purging

Abstract

Up to December 31,1991,130 European teams have reported 1483 autografts for the consolidation of acute myelocytic leukemia (AML). The distribution for autologous bone marrow transplantation (ABMT) was 1040 in first complete remission (CRl) and 331 in second remission. Regarding to pretransplant regimens, total body irradiation (TBI) was delivered in 46% of patients autografted in first remission and 43% of patients autografted in second remission; both in CR 1 and CR2, 20% of patients received an association of Busulfan and Cyclophosphamide. Marrow was purged with mafosfamide in 364 patients (26%). Patients autografted in CR1 with no high risk factor (standard risk) had a leukemia-free survival (LFS) and a probability of persisting remission at 8 years of 41 ± 3% and 52 ± 3%, respectively. For patients autografted in CR2, the LFS and probability of persisting remission were 33 ± 3% and 42 ± 3%. LFS and relapse rates were correlated with several pretransplant intervals: in CR1, patients reaching CR more rapidely (≼ 4O days) had a better LFS (51 ± 3% versus 35 ± 3%; p < 0.001) and a lower relapse rate (43 ± 3% versus 54 ± 3%; p = 0.002). In patients autografted less than 3 months, 3–6 months and more than 6 months after CR, the LFS was 23 ± 6%, 44 ± 4% and 48 ± 4%, respectively (p < 0.0001), and the relapse rates 64 ± 5%, 45 ± 3% and 46 ± 4% (p < 0.0001). In CR2, patients autografted more than 18 months after the initial diagnosis had a better LFS (39 ± 4% versus 26 ± 4%, p < 0.01) and a lower relapse rate (51 ± 5% versus 68 ± 5%, p = 0.0001). For those autografted less than 3 months, 3–6 months and more than 6 months after CR, the LFS was 31 ± 4%, 24 ± 5% and 48 ± 6% (p = 0.03), respectively and the relapse rates 64 ± 4%, 64 ± 7% and 43 ± 7% (p = 0.03).

On behalf of the working party on acute leukemia of the European cooperative group for bone marrow transplantation (EBMT).