VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

RESULTS
From January 1987 to December 1990, a total number of 204 adult patients
were entered into the study. The median age of these patients (male/female =
113/91) was 39.8 years (15-55). 162 patients (79.5 %) achieved complete remission
(CR) after one (n = 148) or two courses (n = 14) of induction chemotherapy
and were given consolidation treatment. After consolidation 26 patients were
excluded for various reasons and 136 patients were still alive in CR.
Ninety-nine patients who could not undergo AlloBMT were given intensification
chemotherapy. A substantial proportion of patients (n = 6) died during
this chemotherapy and 16 other patients could not be randomized for ASCT or
CT.
Finally, 77 patients were randomized for either maintenance CT (n=38) or
ASCT (n=39). The main maintenance CT (n=38) or ASCT (n characteristics of
these two groups were similar (sex ratio age initial WBC count FAB distributing
number of courses for CR). Of the 39 patients allocated to the ASCT arm 33 patients
did undergo ASCT using either bone marrow (n=16) or blood stem cells
(n=17) and six did not because of relapse (n=3), refusal (n=2), or poor hematopoietic
progenitor content in the transplant product (n=l).
In the ASCT group there were two transplant-related deaths (ABSCT=1;
ABMT=1), 18 relapses and finally 19 patients are still alive in first CR 6 to 48
months after ASCT. Among the 38 patients in the CT group 22 patients had leukemic
relapse and 16 patients are still alive in CR 7 to 51 months after obtaining
CR. The actuarial risk of relapse was 48.7 +/- 8.8 % (95% CI) in the ASCT group
and 61.1 +/- 8.4 % (95% CI) in the CT Group (p=N.S). The estimated chance of
surviving without disease at three years was similar in both groups (48.3 +/- 8.5
% and 38.9 +/- 8.4 % respectively) (p=N.S) (Fig 1). Using multivariate analysis
we found that the outcome of the 77 patients who were randomized to receive
either ASCT or CT was not influenced by the type of treatment given after intensification.
No significant difference could be found between ABMT and ABSCT
for the disease free survival and the risk of relapse. However, as previously reported,
the hematopoietic recovery was significantly shorter after ABSCT than
after ABMT.
DISCUSSION
The results we report in this study for ASCT or CT do not differ significantly
from those published elsewhere. In patients undergoing ASCT, we found that
the estimated chance of surviving without disease at three years was 48.3 +/-
8.5%. This is similar to that reported in three other studies which compared
ABMT and AlloBMT. 3
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For patients treated with CT alone, the actuarial proportion
of patients who were still alive in remission at three years was 38.9 +/-
8.4%. This latter result does not differ significantly from that reported elsewhere.
1
Although AlloBMT has been compared extensively with CT, 1
there is no
published prospective study comparing AutoBMT (or ASCT) and CT. This prospective
study shows that there is no major difference between ASCT and maintenance
CT in adult patients with AML in first CR and that the patients who received
the more intensive treatment do not survive longer than other patients. 6
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 13