Autologous Bone Marrow Transplantation - Blog Science Connections

56 ABMTIn CR2
RESULTS OF VARIOUS TREATMENT MODALITIES IN
ACUTE LEUKEMIA AFTER FIRST
COMPLETE REMISSION
After CR1, remission is induced in 40-60% of patients. The long-term
DFS rate is below 10%. We define DFS as a remission lasting longer than 12
months. Inversion, defined as a duration of CR2 longer than that of CR1 or a
duration of third complete remission longer than that of CR2, also occurred in
less than 10% of patients. Our results at The University of Texas M. D.
Anderson Hospital and Tumor Institute at Houston are similar. Remission
reinduction in acute myelogenous leukemia (AML) is 50% and in acute
lymphocytic leukemia 75%. Our continuous complete remission rate is less
than 10%.
Figure 1 diagrams the results of other treatments. Patients treated with
high-dose cytoreductive therapy and allogeneic or isogeneic bone marrow
transplantation have a 35-40% chance of long-term DFS (3). The inversion
rate is identical to the long-term DFS rate. In the patient group treated with
4-hydroperoxycyclophosphamide (4-HC)-purged autologous marrow reported
by Johns Hopkins Hospital, the long-term DFS rate is 30% (5). However, the
inversion rate in that population is 23%. Ramsay has reported that 6 out of 22
patients treated in CR2 or a subsequent remission with monoclonal antibodypurged
marrow plus cyclophosphamide plus total body irradiation (TBI) have
achieved long-term DFS status (6). The inversion rate in this study is 27%.
The updated status of the control group for our forthcoming study,
patients treated in second and subsequent remissions with unpurged marrow
plus CBV, is depicted in Figure 2. Only 4 of the 22 patients had a remission of
ALLOGENEIC BMT: 30-10%.
'INVERSION RATE IDENTICAL
SYNGENEIC BMT:
PURGED - AUTO BMT: INVERSION RATE 23%
Î
UNPURGED AUTO BMT: 1«
NORMAL DOSE CHEMOTHERAPY: 10%
Figure 1. Continuous complete remissions after various treatment modalities in second
and third remissions of acute leukemia. BMT = bone marrow transplantation; auto =
autologous.