Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Graft Outcome

Improved efficiency of remission induction facilitates autologous BMT harvesting and improves overall survival in adults with AML: 108 patients treated at a single institution

Bone Marrow Transplantation volume 27, pages 1045–1052 (2001)Cite this article

Abstract

A hundred and eight patients less than 60 years old with de novo acute myeloid leukemia were treated between 1982 and 1994 by protocols including final intensification with a transplant using autologous bone marrow purged by mafosfamide in first remission in the absence of an HLA-matched sibling donor available for allograft. From 1989, we attempted to improve tumor control by using high-dose anthracyclines in induction, by increasing from one to two the number of consolidation courses pre-transplant and by introducing intermediate doses of cytarabine in the first consolidation course. The CR rate was 77% (33/43) before 1989 and 90% (59/65) after 1989 (P = 0.06). Forty-five out of the 59 patients (76%) who achieved CR after 1989 could undergo bone marrow grafting in CR1 vs 16/33 (48%) before 1989 (P = 0.01). In spite of the higher proportion of patients above 50 years after 1989 (32%) toxicity was mild and an adequate graft was obtained more frequently after one collection. The principal factor relating to improvement in graft feasibility was the post-1989 modification of induction and consolidation regimens. This improvement in graft feasibility was associated with a better disease-free survival (DFS) (48 ± 7% vs 32 ± 8%, P = 0.04) and overall survival (OS) (53 ± 6% vs 30 ± 7%, P = 0.007) at 5 years. By multivariate analysis four factors were associated with overall survival (OS): karyotype, white blood cell count at diagnosis, treatment regimen and bone marrow grafting in CR1. This global approach should be prospectively compared with intensive chemotherapy. Bone Marrow Transplantation (2001) 27, 1045–1052.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Zittoun RA, Mandelli F, Willemze R et al. Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) Leukemia Cooperative Groups New Engl J Med 1995 332: 217–223

    Article  CAS  Google Scholar 

  2. Burnett AK, Goldstone AH, Stevens RMF et al. Randomised comparison of autologous bone marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC-AML 10 trial Lancet 1998 351: 700–708

    Article  CAS  Google Scholar 

  3. Suciu S . Meta-analysis of randomized trials comparing autologous BMT (ABMT) vs chemotherapy (CT) or ABMT vs no further treatment (NFT) as post-remission treatment in adult AML patients Bone Marrow Transplant 1998 21: 43a

    Article  Google Scholar 

  4. Berman E, Little C, Gee T et al. Reasons that patients with acute myelogenous leukemia do not undergo allogeneic bone marrow transplantation New Engl J Med 1992 326: 156–160

    Article  CAS  Google Scholar 

  5. Gorin NC, Labopin M, Fouillard L et al. Retrospective evaluation of autologous bone marrow transplantation vs allogeneic bone marrow transplantation from an HLA identical related donor in acute myelocytic leukemia. A study of the European Cooperative Group for Blood and Marrow Transplantation Bone Marrow Transplant 1996 18: 111–117

    CAS  Google Scholar 

  6. Cassileth PA, Harrington DP, Appelbaum FR et al. Chemotherapy compared with autologous or allogenic bone marrow transplantation in the management of acute myeloid leukemia in first remission New Engl J Med 1998 339: 1649–1656

    Article  CAS  Google Scholar 

  7. Gorin NC, Douay L, Laporte JP et al. Autologous bone marrow transplantation using marrow incubated with ASTA-Z 7557 in adult acute leukemia Blood 1986 67: 1367–1376

    CAS  PubMed  Google Scholar 

  8. Laporte JP, Gorin NC, Lemonnier MP et al. A new combination of two intercalating agents (mitoxantrone + daunomycin) in adult refractory acute leukemia: the DON protocol Cancer Chemother Pharmacol 1988 22: 344–347

    Article  CAS  Google Scholar 

  9. Bloomfield CD . Prognostic factors for selecting curative therapy for adult acute myeloid leukemia Leukemia 1992 6: (Suppl. 4) 65–67

    PubMed  Google Scholar 

  10. Cheson BD, Cassileth PA, Head DR et al. Report of the National Cancer Institute-sponsored workshop on definitions of diagnosis and response in acute myeloid leukemia J Clin Oncol 1990 8: 813–819

    Article  CAS  Google Scholar 

  11. Preisler HD . Failure of remission induction in acute myelocytic leukemia Med Pediatr Oncol 1978 4: 275–276

    Article  CAS  Google Scholar 

  12. Collett D . Modelling Survival Data in Medical Research Chapman Hall: London 1994

    Book  Google Scholar 

  13. Laporte JP, Douay L, Lopez M et al. One hundred and twenty five adult patients with primary acute leukemia autografted with marrow purged by mafosfamide. A 10 year single institution experience Blood 1994 84: 3810–3818

    CAS  Google Scholar 

  14. Gorin NC, Labopin M, Laporte JPh et al. Importance of marrow dose on engraftment and outcome in acute leukemia: models derived from patients autografted with mafosfamide purged marrow at a single institution Exp Hematol 1999 27: 1822–1830

    Article  CAS  Google Scholar 

  15. Schiffer CA, Lee EJ, Takafumi T et al. Prognostic impact of cytogenetic abnormalities in patients with de novo acute nonlymphocytic leukemia Blood 1989 73: 263–270

    CAS  PubMed  Google Scholar 

  16. Tashiro S, Kyo M, Tanaka K et al. The prognostic value of cytogenetic analyses in patients with acute nonlymphocytic leukemia treated with the same intensive chemotherapy Cancer 1992 70: 2809–2815

    Article  CAS  Google Scholar 

  17. Head D, Kenneth JK, Weick J et al. Effect of aggressive daunomycin therapy on survival in acute promyelocytic leukamia Blood 1995 86: 1717–1728

    CAS  PubMed  Google Scholar 

  18. Usui N, Dobashi N, Kobayashi T et al. Role of daunorubicin in the induction therapy of adult acute myeloid leukemia J Clin Oncol 1998 16: 2086–2092

    Article  CAS  Google Scholar 

  19. Ferrant A, Labopin M, Frassoni F et al. Karyotype in acute myeloblastic leukemia: prognostic significance for bone marrow transplantation in first remission: a European Group for Blood and Marrow Transplantation study Blood 1997 90: 2931–2938

    CAS  PubMed  Google Scholar 

  20. Bishop JF, Matthews JP, Young GA et al. A randomized study of high-dose cytarabine in induction in acute myeloid leukemia Blood 1996 87: 1710–1717

    CAS  PubMed  Google Scholar 

  21. Mitus AJ, Miller KB, Schenkein DP et al. Improved survival for patients with acute myelogenous leukemia J Clin Oncol 1995 13: 560–569

    Article  CAS  Google Scholar 

  22. Castaigne S, Archimbaud E, Bordessoule D et al. Sequential induction or double induction chemotherapy increase disease-free survival compared to ‘3 + 7’ chemotherapy in less than 50 years adults with acute myeloid leukemia (AML). 38th Annual Meeting of the American Society of Haematology, Orlando, FA (USA), 6–10 December 1996 Blood 1996 86: 291a (Abstr.)

    Google Scholar 

  23. Mayer RJ, Davis RB, Schiffer CA et al. Intensive post remission chemotherapy in adults with acute myeloid leukemia New Engl J Med 1994 331: 896–903

    Article  CAS  Google Scholar 

  24. Harousseau JL, Cahn JY, Pignon B et al. Comparison of autologous bone marrow transplantation and intensive chemotherapy as post remission therapy in adult acute myeloid leukemia Blood 1997 90: 2978–2986

    CAS  Google Scholar 

  25. Slovak ML, Kopecky KJ, Cassileth PA et al. Karyotypic analysis predicts outcome of pre- and post-remission therapy in adult acute myeloid leukaemia (AML): A SWOG (S9034)/ECOG (E3489) intergroup study Blood 2000 96: 4075–4083

    CAS  PubMed  Google Scholar 

  26. Sierra J, Brunet S, Granena A et al. Feasibility and results of bone marrow transplantation after remission induction and intensification chemotherapy in de novo acute myeloid leukemia J Clin Oncol 1996 14: 1353–1363

    Article  CAS  Google Scholar 

  27. Cassileth PA, Andersen J, Lazarus HM et al. Autologous bone marrow transplant in acute myeloid leukemia in first remission J Clin Oncol 1993 11: 314–319

    Article  CAS  Google Scholar 

  28. Hann IM, Stevens RF, Goldstone AH et al. Randomized comparison of DAT versus ADE as induction chemotherapy in children and younger adults with acute myeloid leukemia. Results of the Medical Research Council's 10th AML trial (MRC AML10). Adult and Childhood Leukaemia Working Parties of the Medical Research Council Blood 1997 89: 2311–2318

    CAS  Google Scholar 

  29. Cahn JY, Labopin M, Sierra J et al. No impact of high-dose cytarabine on the outcome of patients transplanted for acute myeloblastic leukaemia in first remission Br J Haematol 2000 110: 308–314

    Article  CAS  Google Scholar 

  30. Gorin NC, Labopin M, Pichard P et al. Feasibility and recent improvement of autologous stem cell transplantation for acute myelocytic leukaemia in patients over 60 years of age: importance of the source of stem cells Br J Haematol 2000 110: 887–893

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. M Elloumi

    Present address: Service des Maladies du Sang, Hôpital Universitaire de Sfax, Tunisie

Authors and Affiliations

  1. Service des Maladies du Sang, Hòpital Saint Antoine, Paris, France

    F Isnard, JPh Laporte, P Zunic, M Elloumi, N Chéron, S Lesage, L Fouillard, M Aoudjhane, NC Gorin & A Najman

  2. Unité INSERM U444, Faculté de Médecine, Saint Antoine, Paris, France

    M Guiguet

  3. Centre de Recherches sur la Thérapie Cellulaire (EA 1638 et centre Claude Bernard) CHU Saint Antoine, Paris, France

    JPh Laporte, S Lesage, L Fouillard, M Lopez & NC Gorin

  4. Laboratoire d'Immunologie et d'Hématologie Biologique, Hôpital Saint Antoine, Paris, France

    J Deloux

  5. Laboratoire de Cytogénétique Hématologique, Hôpital Saint Antoine, Paris, France

    J Van Den Akker

  6. Laboratoire d'Hématologie, Hôpital Trousseau, Paris, France

    L Douay

Authors
  1. F Isnard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Guiguet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. JPh Laporte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P Zunic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Elloumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N Chéron
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Deloux
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J Van Den Akker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S Lesage
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. L Fouillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M Aoudjhane
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. L Douay
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. NC Gorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. A Najman
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Isnard, F., Guiguet, M., Laporte, J. et al. Improved efficiency of remission induction facilitates autologous BMT harvesting and improves overall survival in adults with AML: 108 patients treated at a single institution. Bone Marrow Transplant 27, 1045–1052 (2001). https://doi.org/10.1038/sj.bmt.1703031

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1703031

Keywords

This article is cited by

Search

Advanced search

Quick links