Autologous Bone Marrow Transplantation - Blog Science Connections

Purged ABMT in CR of Acute Leukemia 17
All patients received the same basic, intensive pretransplant regimen
consisting of CY, 60 mg/kg/day x 2 plus mesna, 60% of the CY dose; and TBI,
10 Gy with lung shielding at 8 Gy.
Twenty-four hours after TBI, the bags of frozen purged marrow were
thawed rapidly in a water bath at 37°C and the marrow infused immediately.
Day 0 was defined as the day of marrow infusion. Mo maintenance chemotherapy
was used after autografting.
Between January 1983 and October 1986,57 patients entered the study;
37 were men. The patients' age range was 6-55 years, the median age being 35
years; 15 patients were older than 40 and 4 younger than 15 years of age. Of
acute lymphocytic leukemia (ALL) patients in first remission (CR1), 5 were
considered standard-risk and 13 were considered high-risk patients; 3 ALL
patients were in second remission (CR2). Of acute myelocytic leukemia (AML)
patients in CR1,26 were considered standard-risk and 6 high-risk patients; 4 of
the AML patients were in CR2. For patients in CR1, the median interval from
remission to ABMT was 6 months (range, 2-15 months), and for patients in
CR2 the median interval was 4 months (range, 0.5-12 months).
Criteria for the high-risk classification were: At diagnosis—leukocytes >25
x 10 9 /l, mediastinal enlargement on chest x ray, presence of a Philadelphia
chromosome, extrahematopoietic localization (other than in CNS), and
secondary leukemia; before ABMT—CNS involvement at anytime; at ABMT—
evidence of partial remission and no CR, lactic dehydrogenase of 1,000 CI.
Of 20 patients in the high-risk category, 12 had two or more of these
conditions. By usual transplantation standards, the population of patients was
relatively old since 15 patients were over 40 years of age. Twenty-one patients
had ALL (CR1, 18; CR2, 3), and 36 had AML (CR1, 32; CR2, 4). The median
intervals from diagnosis and remission to ABMT were 6 months for the ALL and
4 months for the AML patients. Longer delays arose mainly from difficulties in
harvesting rich CR marrow with no residual leukemic cells detectable by
appropriate means and from inappropriate incubation procedures with
mafosfamide that led to residual CFC1-GM fractions not in keeping with the study
design.
RESULTS
Patients With Acute Myelogenous Leukemia
Of the 26 patients with standard-risk AML who received autografts during
their CR1, 18 (69%) have remained disease free so far, and they have been
followed up a median of 11 months (range, 4-42 months). Seven patients have
a follow-up of longer than 1 year, five beyond 2 years, and three beyond 3 years.
Eight patients died of toxic reactions, five during the ABMT procedure (two as a
result of sepsis, one of viral infection, one of graft failure, one of liver venoocclusive
disease [VOD]), and three patients died while in continuous complete