autologous blood and marrow transplantation - Blog Science ...

Table 2. Autologous BMT in ALL in first remission
Rowe 59
Reference No. patients Median age (years) Disease-free survival
EBMT, 1995 10 834 30(18-51) 42 ± 4 (8 years)
Fière, 1993 8 63 NS 51 (5 years)
Blaise, 1990 12 22 31 (7^17) 40 (3 years)
Kantarjian, 1990 13
26 30 60 (3 years)
Carey, 1991 14 15 30(18-51) 57 (3 years)
Powles, 1995 15 50 26 (15-58) 53 (3 years)
Vey, 1994 16 34 29(16-59) 27 (8 years)
Attal, 1995 17 64 NS 29 (3 years)
reports (Table 2). The problem is that so little of this is controlled, and there has
only been one previous prospective study attempting to define the role of
autologous bone marrow transplantation. 8
Data from the European Transplant
Bone Marrow Group describe a disease-free survival of 42% among "standard
risk" patients. 78
However, it must be remembered that these are retrospective data
taken from a multitude of centers with patient selection making interpretation
difficult.
The French study reported by Fière in 1993 8
suggested, in a prospective study,
that the response to autologous bone marrow transplantation may be at least as
good as conventional chemotherapy. It is reassuring that the recent update 11
of this
study has not changed very much, with a median follow-up now of more than 8
years (Table 3). In this prospective study, allogeneic transplantation remains statistically
superior among patients with "high-risk" ALL emphasizing, with long-term
follow-up, the potential for cure in this group.
Nevertheless, the entire issue of autologous bone marrow transplantation
remains uncertain, as is the precise role of allogeneic BMT in first remission for
patients who are not at high risk. A major prospective study is currently underway
with a trans-Atlantic effort between the Eastern Cooperative Oncology Group in
the United States and the Medical Research Council in Britain (ECOG 2993 and
Table 3. Allogeneic and autologous BMT in first complete remission French Group on
Therapy of Adults ALL—Fiere et al.
Post-CR (intent-to-treat) Allogeneic BMT Autologous BMT Chemotherapy
n 116 95 191
DFS 43% _ 39% 32%
JCO, 1993 8
DFS 46% 34% 30%
ASCO, 1998 11
High risk 44% 16% 11%
Standard risk 49% 49% 39%