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

COMPARISON OF INTENSIVE CONSOLIDATION CHEMOTHERAPY
(ICC) AND UNPURGED AUTOLOGOUS BONE MARROW
TRANSPLANTATION (ABMT) AS POST REMISSION THERAPY IN
ADULT ACUTE MYELOID LEUKEMIA (AML).
JL Harousseau*, JY Cahn, B Pignon, D Mignard, F Witz, C Linassier, N Ifrah,
B Lioure, D Caillot, F Guilhot, JF Abgrall, PY Leprise, D Guyotat, P Casassus,
J Briere, F Mors, B Desablens, P Hurteloup on behalf of the GOELAM group.
* Department of hematology - C.H.U. NANTES - FRANCE
INTRODUCTION
Recently published series have shown that a disease free survival of 30 to
50% could be achieved after short term Intensive Consolidation Chemotherapy
(ICC) without maintenance treatment 15
. Autologous Bone Marrow Transplantation
(ABMT) after myeloablative treatment is another attractive approach. In pilot
single center studies or in the annual survey of the European registry, disease
free survival rates around 50% were obtained However in all these studies,
the issue of patient selection was raised. Thus, randomized studies comparing
ABMT and ICC were mandatory. In 1987, the French group GOELAM initiated
such a study.
PATIENTS AND METHODS
Patients (pts) aged 15 to 50 years with de novo AML were included in a
multicenter study involving 16 centers of the GOELAM group. Pts with preexisting
myelodysplastic syndromes or with blastic transformation of chronic
myeloproliferative disorders were not included. Chemotherapy/radiation-induced
leukemias were also excluded. From November, 1987 to December 1991,
318 pts were enrolled and 308 pts are évaluable.
INDUCTION TREATMENT
Patients were randomized to induction treatment between Cytarabine (Ara-
C) 200 mg/m 2
/d (continuous infusion) for 7 days plus Idarubicin (IDR) 8 mg/
m 2
/d IV for 5 days and ARA-C at the same dosage plus Zorubicine (ZRB) 200
mg/m 2
for 4 days. A bone marrow aspiration was performed at day 17: if the
marrow remained blastic (< 50% blasts) a second course was administered with
3 days of Ara-C plus 2 days of either IDR 10 mg/m 2
/d or ZRB 200 m g /m 2
/d .
POST REMISSION TREATMENT
Pts in complete remission (CR) were allografted if they were under the age
of 40 years and had an HLA-identical sibling. The conditioning regimen and the
graft versus host disease prophylaxis and treatment varied according to protocols
used in the different transplant centers. Pts over 40 years or without a suitable
donor received a first course of ICC (ICC1 ) Ara-C (3 g/m 2
in 3 hours infusion
every 12 hours for eight doses, dl to d4) and either IDR 10 mg/m 2
/d d5-6
16 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION