Allogeneic bone marrow transplantation for acute myeloid leukemia in first complete remission: The effect of FAB classification and GVHD prophylaxis

F. Fagioli, A. Bacigalupo, F. Frassoni, M. T. Van Lint, D. Occhini, F. Gualandi, T. Lamparelli, M. Clavio, V. Vitale, G. Sogno, G. L. Castoldi, A. M. Marmont

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Abstract

Ninety-one patients with de novo acute myeloid leukemia (AML) in first complete remission (CR) undergoing an HLA-identical sibling BMT and with a minimum follow-up of 12 months were analyzed for disease-related and transplant-related variables predicting survival and relapse. The overall actuarial 5 year survival is 53% and the relapse rate 29%, with a medium follow-up for surviving patients of 1552 days (range 365-4094 days). In univariate analysis the following variables were found to be associated with an increased risk of failure: high-dose cyclosporin (CsA), M4-M6 FAB subtype and a long interval (≥180 days) between diagnosis and BMT. Other disease-related variables at presentation were not significant, including WBC count > 50 X 109/l, marrow blasts <70%, time to enter remission > 40 days and > 2 courses to enter remission. Survival was 58% vs 43% for M1-M3 vs M4-M6 FAB subtypes (p = 0.03) and 71% vs 42% for low-dose vs high-dose CsA (p = 0.01). A multivariate analysis was then run separately on survival, relapse and transplant related mortality (TRM). Survival was negatively influenced by M4-M6 FAB subtypes (p = 0.009), high-dose CsA (p = 0.03) and a long interval between diagnosis and BMT (p = 0.04). Leukemia relapse was higher in patients receiving high-dose CsA (p = 0.003) and in females (p = 0.04). Transplant-related mortality was higher in FAB M4-M6 patients (p = 0.01) and patients grafted late after diagnosis (p = 0.03). In conclusion, this study confirms that (1) low-dose post-graft immunosuppression has a positive effect on survival and relapse, (2) patients with M4-M6 AML have a poorer outcome due to a greater transplant-related mortality, and (3) that late transplants (> 6 months from diagnosis) also seem to have a worse prognosis. These data suggest that results of allogeneic BMT in AML can be improved by modifications of the transplant protocols.

Original languageEnglish
Pages (from-to)247-252
Number of pages6
JournalBone Marrow Transplantation
Volume13
Issue number3
Publication statusPublished - 1994

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ASJC Scopus subject areas

  • Hematology
  • Transplantation

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