V Autologous Bone Marrow Transplantation_2.pdf - Blog Science ...

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Session 1: Acute Myelogenous Leukemia - CR1
after induction treatment has contributed significantly to the long term DFS
rate. 3,4
On the basis of the principle of intensification of remission, we initiated
8 years ago a post remission induction treatment in which in addition to the
early HD Ara-C intensification, a subsequent intensification program was
included. This consisted of high dose Cyclophosphamide, BCNU and VP-16
(CBV) in conjunction with autologous bone marrow transplantation (auto-BMT).
In this paper, we report a follow-up of the results and we describe our current
study.
MATERIALS AND METHODS
Patient Population
Patients under age 60, diagnosed with AML using the FAB criteria
were entered in protocol 82-86 approved by the Institutional Review Board
(IRB). Schema 1 presents a schematic design of this protocol. A minimum of
1x10 s
marrow cells/kg body weight was collected after the first second or third
maintenance course after HD Ara-C treatment. The methods of marrow storage
and preparation procedures of the marrow cells for transplantation have been
described previously. 3 The CBV regimen has been documented in Schema 2.
RESULTS WITH PROTOCOL 82-86
Of the 63 patients achieving CR, 18 were treated with CBV and BMT
as second intensification (Schema 3). Of the 18 patients, 10 are in continuous
complete remission (CCR) with a median follow-up of over 5 years (Table 1).
Eight patients relapsed after a median remission duration of 19 months (Table
2). Of the 18 patients, 12 had favorable prognostic factors according to
Keating's model 2 , 8 (67%) are in CCR. Of the 6 patients with unfavorable
prognosis, only 2 are still in remission (Table 3). There is no transplantation
related mortality.
As can be noted in Schema 3,45 of 63 patients who achieved remission
were not transplanted. One of the major reasons of not being entered into the
transplantation program is relapse of leukemia occurring within 6 months after
remission induction; over 20% of the patients relapsed before reaching the
transplantation phase in the protocol (Schema 3). The majority of the relapses
is after the course of maintenance immediately after CR induction and after the
second and third course of maintenance after HD Ara-C intensification (Schema
1).
CURRENT AML PROGRAM (#273-90)
Based on our experience with protocol 82-86, two major changes have
been introduced in the new protocol. In the first place the maintenance
treatment after induction has been deleted and the time interval between HD
Ara-C treatment and transplant has been shortened; only one maintenance
course has been included. The marrow for transplantation is harvested