ISSN:
1569-8041
Keywords:
ABMT
;
AML
;
high-dose treatment
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background:Debate and controversy remain as to the optimalpost-remission therapy for younger patients with acute myelogenous leukaemia(AML). The aim of this study was to evaluate high-dose treatment (HDT) withautologous bone marrow support (ABMS) as consolidation of first completeremission (CR). Patients and methods:One hundred forty-four patients (AML-M3excluded, median age 38 years, range 15–49 years) received remissioninduction therapy comprising: adriamycin 25 mg/m2, days 1–3,cytosine arabinoside (ara-C) and 6-thioguanine, both at 100 mg/m2bid, days 1–7. Patients in whom CR was achieved received two furthercycles of the same treatment prior to bone marrow being harvested andcryopreserved. HDT comprised ara-C: 1 g/m2 b.i.d. × six daysand total body irradiation (TBI): 200 cGy b.i.d. for three days. Thawedautologous marrow was then re-infused. Results:Complete remission was achieved in 106 of 144 patients(73%) who were thus eligible to receive ara-C + TBI + ABMS; 61 actuallyreceived it. Following HDT, the median time to neutrophil recovery (〉0.5× 109/l) was 25 days (range 11–72 days) and to plateletrecovery (〉20 × 109/l), 42 days (range 15–159 days).There were eight treatment-related deaths. Analysis by `intention to treat'shows both remission duration (log-rank, P= 0.001) and survival(log-rank, P= 0.004) to be significantly longer for the 106 patientseligible to receive HDT than for a historical control group (n= 133)who received identical remission induction and consolidation therapy butwithout ara-C + TBI + ABMS. With a median follow-up of 5.5 years, 39 of 106patients remain in CR (37%) and 54 (51% of those in whom CR wasachieved) remain alive, with a predicted actuarial survival of 52% at5 years. Conclusions:The addition of ara-C + TBI + ABMS to conventionalconsolidation therapy significantly improved remission duration and survivalover those of a historical control group of patients with AML (aged 〈50,AML-M3 excluded). HDT was, however, associated with significanttreatment-related mortality and slow blood count recovery. The use of ara-C+ TBI supported by peripheral blood progenitor cells should make the treatmentsafer and more widely applicable in AML.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1008333903220
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