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

Engraftment of granulocyte, monocyte and erythrocyte precursors was
prompt in most patients. Median observed recovery times for neutrophils to 500
cells/uL were 33,37 and 41 days for the first CR, second/third CR and first relapse
patients respectively. Median times to reach platelet counts of greater than
20,000 and greater than 50,000 uL were 50 and 90 days (first CR), 42.0 and 69
(second/third CR) and 49 and 79 days (first relapse). Median times in days to
reach a hemoglobin concentration of greater than 10g% were 71,46, and 67 for
first CR, second and third CR and first relapse patients, respectively.
Relapse
Three first CR patients relapsed at 11,17 and 43 months post-ABMT. At the
time of ABMT the median CR1 duration of the patients that relapsed was 12.3
months. The median pre-ABMT CR durations of the other four first CR patients
now surviving relapse-free after the transplant was 7.3 months (range 6-11).
Fourteen second/third CR patients relapsed at times ranging from 1.5 to 30
months post-ABMT, (median 4.2 months), and their median time in first complete
remission was 9.8 months. Two patients transplanted in first relapse relapsed
at 6 and 12 months post-ABMT.
Survival
Relapse-free survival from transplant of all patients as of August 1,1992 is
shown in Figure 1, by CR group. The median relapse-free survival of the CR1
group is 1762 days (59 months) after ABMT. Four of the seven patients remain in
CR at 666 (22 months), 1723 (57 months), 1800 (60 months) and 2100 (70 months)
days post ABMT respectively. Actuarial two and three year disease free survival
is 71% and actuarial two and three year relapse rate or death is 29%.
The patients transplanted in CR2/3 have an actuarial two and three year
disease-free survival of 36% and 32% respectively. The median relapse-free survival
of this group post-ABMT is 32 months. The two and three relapse year
rates are estimated to be 42% and 49%. For those patients transplanted in first
relapse, the two and three year actuarial disease-free survival is 36% while the
estimated two and three year relapse rate is 43%. The median relapse-free survival
of this qroup post-ABMT is 10 months.
Data analysis by treatment regimen (Bu/CY vs. CY/TBI) yields encouraging
results (Figure 2). The two and three year disease-free survival of patients
who received CY/TBI as the conditioning regimen are 33% and 30% respectively,
while those patients who received Bu/CY have two and three year DFS
of 53% (P-0.08).
Further analysis by regimen of the high risk patients only (patients transplanted
in CR 2/3 and Rl) reveal statistically significant benefit for those patients
conditioned with BU/CY (Fig. 3). Twenty-seven patients in CR 2/3 and
Rl received Bu/CY. They have actuarial two and three year DFS of 53% while
29 CR2/3, Rl patients conditioned with CY/TBI have 24% and 21% two and
three year DFS (p = .02). In addition, analysis of the 9 Rl patients conditioned
with Bu/CY reveal a two and three year DFS of 56%.
24 SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION