High incidence of extramedullary relapse of AML after busulfan/cyclophosphamide conditioning and allogeneic stem cell transplantation

D. R. Simpson, T. J. Nevill, J. D. Shepherd, H. C. Fung, D. E. Horsman, S. H. Nantel, L. M. Vickars, H. J. Sutherland, C. L. Toze, D. E. Hogge, H. G. Klingemann, S. C. Naiman, M. J. Barnett

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52 Scopus citations

Abstract

While allogeneic stem cell transplantation (SCT) is curative for a significant number of patients with AML, relapse of disease within the bone marrow and/or extramedullary (EM) sites following high-dose therapy continues to limit the success of this treatment. Between October 1985 and December 1996, 81 adults underwent allogeneic SCT for de novo AML at our centre. Forty-two patients remain alive and free of leukaemia with a median follow-up of 50 months. The 5-year actuarial event-free survivals (EFS) for all patients and for those undergoing SCT in CR1 or with advanced disease were 46% (95% confidence interval (CI) 34-58%), 63% (CI 46-76%), and 19% (CI 7-36%), respectively. Twenty-two patients relapsed at a median of 8 (range 1.6-54.5) months with the actuarial risk of relapse for all, CR1 and advanced disease patients being 38 %, (CI 27-52%), 23% (CI 13-40%) and 68% (CI 46-88%), respectively. Ten patients relapsed at EM sites; six of these (27% of relapses) had an isolated EM relapse at a median of 31 (range 8.5-54) months. Three of the patients with isolated EM relapse survived ≤ 24 months following relapse and two patients remain disease-free at 29+ and 33+ months. BuCy conditioning followed by allogeneic SCT in AML results in satisfactory EFS although there is a significant risk of late isolated EM relapse.

Original languageEnglish
Pages (from-to)259-264
Number of pages6
JournalBone Marrow Transplantation
Volume22
Issue number3
DOIs
StatePublished - 1998

Keywords

  • Adolescent
  • Adult
  • Busulfan/administration & dosage
  • Cyclophosphamide/administration & dosage
  • Disease-Free Survival
  • Female
  • Graft vs Host Disease/etiology
  • Hematopoietic Stem Cell Transplantation/adverse effects
  • Humans
  • Immunosuppressive Agents/administration & dosage
  • Leukemia, Myeloid, Acute/drug therapy
  • Male
  • Middle Aged
  • Recurrence
  • Transplantation Conditioning/adverse effects
  • Transplantation, Homologous

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