autologous blood and marrow transplantation - Blog Science ...

32 Chapter 1:AML
Table 3. Probability of 1-, 2-, and 3-year survival by regimen and remission status
Overall survival Disease-free survival
Factor n / year 2 years 3 years 1 year 2 years 3 year
Remission status
CR1 23 0.54 0.50 0.50 0.50 0.50 0.50
CR2/3 87 0.46 0.36 0.33 0.40 0.32 0.27
Rl 28 0.56 0.40 0.35 0.33 0.33 0.33
Conditioning regimen
Cy/TBI 35 0.46 0.37 0.34 0.37 0.34 0.31
BU/Cy 93 0.53 0.42 0.39 0.44 0.37 0.34
BU/VP16 10 0.30 0.20 — 0.20 0.20
Conditioning regimen/status
CR1
Cy/TBI 7 0.87 0.71 0.71 0.71 0.71 0.71
BU/Cy 12 0.45 0.45 0.45 0.45 0.45 0.45
BU/VP16 4 0.25 0.25 0.25 0.25 0.25 —
CR2/3
Rl
Cy/TBI 26 0.35 0.31 0.27 0.31 0.27 0.23
BU/Cy 55 0.54 0.49 0.38 0.47 0.36 0.31
BU/VP16 6 0.33 0.17 — 0.17 0.17 —
Cy/TBI 2 0.5 — — 0 — —
BUCy 26 0.56 0.43 0.38 0.37 0.37 0.37
mAb-based techniques using antimyeloid mAbs have been used to purge AML
marrow. This report updates our > 10-year multi-institutional clinical data of
autoBMT in AML with mAb and C'-mediated purging. As with allogeneic BMT,
the results are dependent on remission status. Five-year DFS for patients
transplanted in Rl and CR2/3 who were conditioned with Bu/Cy2 were 37 and
28%, respectively. These results compare favorably with those of allogeneic
4 3 1
BMT.
Significant prognostic factors operating in our study were length of first CR (for
patients transplanted in Rl or CR2/3) and sex. Interestingly, patients with
secondary AML or extramedullary disease did not fare worse. Nor did cytogenetics
of AML cells at diagnosis affect outcome (although some of the patient subgroups
were small). These results are surprising, since prior central nervous system (CNS)
disease and cytogenetic abnormalities have been associated with worse outcomes
in previous studies. 32-34
We have conducted a phase II clinical trial of monoclonal antibody purging of
bone marrow in patients with AML in remission at the time of harvest and in
remission or relapse at the time of transplant. The overriding question raised by the