Autologous Bone Marrow Transplantation - Blog Science Connections

ABMTin CRI 47
DFS rate for the CBV-treated group and a 50% projected DFS rate for the control
group. Since the study was not randomized, a P value was not determined.
The mortality immediately after transplantation was 0. The median
recovery to 500 absolute granulocytes was 34 days, and the recovery to 50,000
platelets was 41 days after transplantation.
The ALL investigation also proposed to study the biologic role of
intensification with CBV and unpurged ABMT. All patients under 60 years were
to be entered into the BMT protocol, of whom 25 or 30 would receive the
intensification regimen; since the study is one-armed, the data were to be
compared with a nonconcurrent control group achieving the best available
chemotherapy results. Only 11 patients have been transplanted so far. Seven
are alive and in continuous CR after a median follow-up from the onset of CR of
more than 18 months (range, 8-30 months). Three patients have relapsed. The
immediate posttransplantation mortality in this group is 0; however, one patient
in CR died of herpes zoster 5 months after ABMT. Additional patients have been
entered in the study, but it is too early to evaluate the results. The median time to
recovery to 500 granulocytes is 24 days, and to 50,000 platelets, 34 days.
Hematopoietic recovery is significantly faster for ALL than for AML (P = .05).
DISCUSSION
Our results for AML in remission are identical to the European results (3):
Gorin reports a 60% DFS rate in ALL and AML in the European studies (see
Gorin et al. "use of Bone Marrow Incubated With Mafosfamide in Adult Acute
Leukemia Patients in Remission: The Experience of the Paris Saint-Antoine
Transplant Team," in this volume). Although the data are encouraging,
interpretation is difficult. Patient selection may be the cause of the high DFS rate
after ABMT. A randomized study to compare the results of ABMT and normaldose
chemotherapy is necessary. In a randomized study between ABMT and
allogeneic bone marrow transplantation in CR, Lowenberg reported no
difference in results (see Lowenberg et al. "Autologous Bone Marrow Transplantation
in Patients With Acute Myeloid Leukemia in First Remission," in this
volume).
Despite the shortcomings in interpreting the data, we noted an unexpectedly
high DFS rate after unpurged ABMT, raising questions about the potential of
infusing leukemic cells and, therefore, the role of purging in CR1.
REFERENCES
1. Dicke KA, Zander AR, Spitzer G, Verma DS, Peters L, Vellekoop L, McCredie KB. Lancet
1979;1:514.
2. Spitzer G, Ventura G, Hortobagyi G, Dicke KA. In Recent Advances in Bone Marrow
Transplantation, UCLA Symposia on Molecular and Cellular Biology, New Series, vol. 53,
Gale RP, Champlin R, eds. Alan R. Liss, New York, 1986.
3. Linch DC, Burnett AK. In Clinics in Haematology, vol. 15, Goldstone AH, ed. W. B. Saunders,
London, 1986:167.