autologous blood and marrow transplantation - Blog Science ...

Table 1. Outcome after relapse in MRC AML 10
AutoBMT NoBMT
Burnett 13
% in CR2 % Survival at 2 years
(n) (n) AutoBMT NoBMT AutoBMT NoBMT
All 60 101 34 59 15 18
Risk group
Good 12 20 67 90 38 38
Standard 35 59 31 54 12 9
Poor 11 11 10 45 0 15
Unknown 6 11 33 45 17 9
Age group (years)
0-14 15 26 27 65 18 35
15-34 18 25 56 48 7 16
>35 31 50 26 62 17 12
From Burnett et al. 9
to be sure they are cured, it does seem a reasonably secure strategy to delay transplant
in these groups. The trial data demonstrate that 40% will become long-term survivors
with chemotherapy only, and about a third of those who relapse can be rescued.
These data preceded the introduction of all frans-retinoic acid for patients with
acute promyelocytic leukemia. This development improves the prospect of cure
without transplantation and further endorses the strategy of delaying transplant in
this subgroup (Burnett AK, Grimwade D, Solomon E, Wheatley K, Goldstone AH,
manuscript submitted). 13,14
For patients in other risk groups, e.g., poor- or standard-risk or patients >15 years
old, the prospects of salvage after relapse are much less reliable (Table 1). While there
remains uncertainty about the best approach to consolidation, it is probably unwise to
rely on rescuing patients who relapse. In contrast, it remains a priority to optimize firstline
treatment. The relapse risk can be reduced in these patients by more treatment than
the four intensive courses given in MRC AML 10, but it is important to harness this
effect with minimal toxicity. In standard risk, or patients >35 years old, the mortality
in the autograft patients was 16 and 18%, respectively, so there is an opportunity to
reduce treatment-related risk and thereby harness the antileukemic effect of autograft.
While the MRC trial provides important evidence that more is better, it remains to be
tested whether this is best achieved with a transplant or further chemotherapy. This is
the central question on the ongoing MRC12 trial.
REFERENCES
1. Mayer RJ, Davis RB, Schiffer CA, Berg DT, Powell BL, Schulman P, Omura GA, Moore
JO, Mcintyre OR, Frei E: Intensive postremission chemotherapy in adults with acute
myeloid leukemia. N Engl J Med 331:896-942, 1994.