Autologous Bone Marrow transplantation - Blog Science Connections

24 Timing of BMT for ANL
'SURVIVAL' AFTER ACHIEVING FIRST REMISSION
Projected effect of treatment strategy
Chemotherapy only (SWOG) Transplant 1st remission
Transplant untreated 1st relapse
Figure 1. Shown are the Kaplan-Meier probabilities of survival after achieving a first
CR for 220 patients transplanted in Seattle while in first CR ( ), 392 adults less
than age 50 treated with chemotherapy on two sequential SWOG trials ( ), and
the theoretical survival of the SWOG patients if every patient who failed chemotherapy
were transplanted from a matched sibling at first untreated relapse (-- --).
In summary, for patients with ANL who have recently achieved
a complete remission and have an appropriate donor, transplantation
during first remission is probably preferred. But for some patients,
transplantation at the time of first relapse may represent an
appropriate time is a reasonable alternative.
Autologous Marrow Transplantation
It is more difficult to reach conclusions about the timing of
autologous transplantation. None of the reported studies of autologous
transplantation for patients in first remission identified patients at
diagnosis, and thus selection bias may have been substantial. These
studies generally consisted of small numbers of patients, and followup
was limited. For these reasons, results have been highly variable,
with three-year survivals ranging from 20% to 60% [reviewed in
reference 13]. Thus, any advantage of autologous transplantation in
first remission over continued chemotherapy has yet to be definitively
demonstrated. Further, it is unknown how many patients with ANL
who relapse from conventional chemotherapy can be salvaged with