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Acute Myeloid Leukemia

Long-term outcome after intensive therapy with etoposide, melphalan, total body irradiation and autotransplant for acute myeloid leukemia

Bone Marrow Transplantation volume 33, pages 1201–1208 (2004)Cite this article

Summary:

Intensive therapy and autologous blood and marrow transplantation (ABMT) is an established post-remission treatment for acute myeloid leukemia (AML), although its exact role remains controversial and few data are available regarding longer-term outcomes. We examined the long-term outcome of patients with AML transplanted at a single center using uniform intensive therapy consisting of etoposide, melphalan and TBI. In all, 145 patients with AML underwent ABMT: 117 in first remission, 21 in second remission and seven beyond second remission. EFS and OS were significantly predicted by remission status (P<0.0001). For transplantation in first remission, 8 year EFS and OS were 55% (95% CI, 44–64%) and 62% (95% CI, 50–72%), respectively. By multivariate analysis, only age (P=0.04) and cytogenetic risk group (P=0.006) influenced OS. For patients transplanted in second remission, 8 year EFS and OS were 30% (95% CI, 9–55%) and 36% (95% CI, 13–60%), respectively. No pre-transplant variables significantly predicted outcome. None of the seven patients who underwent ABMT beyond second remission or in early relapse were long-term survivors. ABMT can provide long-term antileukemic control for patients with AML in first remission. For patients in second remission approximately 30% can achieve cure with ABMT, and this option may be preferable to alternate donor allogeneic stem cell transplantation.

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Acknowledgements

AK holds the Gloria and Seymour Epstein Chair in Cell Therapy and Transplantation at University Health Network and the University of Toronto. We thank Qi-Long Yi for his assistance with the statistical analysis of the data.

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  1. Department of Hematology, University of Toronto Autologous Blood and Marrow Transplant Program, Princess Margaret Hospital/Ontario Cancer Institute, Toronto, ON, Canada

    P Mollee, V Gupta, K Song, V Reddy, N Califaretti, R Tsang, M Crump & A Keating

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  1. P Mollee
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  2. V Gupta
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Correspondence to P Mollee.

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Mollee, P., Gupta, V., Song, K. et al. Long-term outcome after intensive therapy with etoposide, melphalan, total body irradiation and autotransplant for acute myeloid leukemia. Bone Marrow Transplant 33, 1201–1208 (2004). https://doi.org/10.1038/sj.bmt.1704506

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