Long-Term Results of Autologous Bone Marrow Transplantation in Adult Acute Lymphoblastic Leukemia

Abstract

Autologous bone marrow transplantation (BMT) is widely performed in both adult and high-risk pediatric acute lymphoblastic leukemia (ALL). Nevertheless, there is still a lack of definitive data concerning its real effectiveness in prolonging the survival of these patients. Between 1984 and 1992, 20 ALL patients in first, second and third complete remission (CR) underwent autografting in the BMT Unit of the University of Milan. This series included 3 children in CR after one or more hematological relapses while all the other patients were adult. Autologous bone marrow was harvested during the same disease phase as that in which the autologous BMT was performed. The conditioning regimen included high-dose Ara-C, cyclophosphamide and TBI 1000 cGy. Successful engraftment occurred in all patients; no early deaths or deaths in CR were recorded, making disease-free survival and event-free survival (EFS) curves superimposable. The overall chance of EFS at 72 months was 41%: 57% for patients in first CR, 53% for patients autografted after one or more isolated meningeal relapse, 14% for patients autografted after one or more hematological relapse. The present data do not provide any evidence to support a role for autologous BMT in prolonging EFS in first CR ALL patients. Nevertheless, the results after meningeal relapse seem to be favourable when compared with the disappointing prospects of these patients after conventional chemotherapy. The EFS after hematological relapse revealed by this study does not significantly differ from that reported in the majority of other studies: the efficacy of autologous BMT in these ALL patients is doubtful.

Idarubicin to intensify the conditioning regimens of autologous bone marrow transplantation for patients with acute myeloid leukemia in first complete remission

“…33 Maintenance of complete remission after remission-induction therapy for AML can be achieved by intensive consolidation therapy followed by allogeneic or autologous stem cell transplantation or by chemotherapy. 8,[12][13][14] Allogeneic BMT usually results in the highest disease-free survival, but its use is limited to younger patients with HLA-identical siblings. 11,12 Autologous BMT for AML in CR1 did not improve overall survival compared to intensive consolidation therapy, mainly due to a more effective salvage therapy for those patients who relapsed after chemotherapy.…”

“…14,15 Relapse is the main cause of death in hematologic malignancies after BMT, and even more so after ABMT. Combining the standard conditioning regimens (cyclophosphamide/busulphan and cyclophosphamide/TBI) with non-cross-resistant agents and selecting agents without overlapping toxicity may improve its efficacy.…”

“…9,10 Allogeneic BMT as well as ABMT in de novo AML patients when performed during CR1 results in better DFS than intensive consolidation therapy [11][12][13] and greater antileukemic activity when performed in CR2. 14,15 Relapse is the main cause of death in hematologic malignancies after BMT, and even more so after ABMT. Combining the standard conditioning regimens (cyclophosphamide/busulphan and cyclophosphamide/TBI) with non-cross-resistant agents and selecting agents without overlapping toxicity may improve its efficacy.…”

Autologous stem cell transplant in ALL: who should we be transplanting in first remission?

“…More recently, autologous stem cell transplant (ASCT) has been evaluated in patients in first remission, with leukemia-free survival at 5 years reported to be from 45 to 65% in published studies. [3][4][5][6][7][8][9][10][11][12] Few prospective, randomized trials have analyzed large enough numbers of patients to allow us to determine the appropriate therapy for all patients with ALL. Based on the studies that are currently available, the general consensus regarding treatment of ALL in adults is as follows: [13][14][15][16] (1) Allogeneic transplant from an HLA identical sibling is the treatment of choice in non-elderly adult patients with ALL in first remission.…”