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Improved outcome for high-risk acute myeloid leukemia patients using autologous bone marrow transplantation and monoclonal antibody-purged bone marrow

Academic Article
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Overview

authors

  • Selvaggi, K. J.
  • Wilson, J. W.
  • Mills, L. E.
  • Cornwell, G. G.
  • Hurd, D.
  • Dodge, W.
  • Gingrich, R.
  • Martin, S. E.
  • Mc Millan, Robert
  • Miller, W.
  • Ball, E. D.

publication date

  • March 1994

journal

  • Blood  Journal

abstract

  • We have conducted a 9-year multicenter trial of autologous bone marrow transplantation (ABMT) for acute myeloid leukemia (AML). Remission BM was purged in vitro using monoclonal antibodies (MoAbs; PM-81, AML-2-23) and complement targeting myeloid differentiation antigens (CD15, CD14). In 1988, the preparative regimen changed from 60 mg/kg/d cyclophosphamide x 2 and fractionated total body irradiation (TBI) total dose, 1,200 cGy (Cy/fTBI), to 4 mg/kg/d busulfan x 4 and 60 mg/kg/d Cy x 2 (Bu/Cy2). Recent analysis (October 1, 1993) shows that the Bu/Cy2 regimen along with the same MoAb purging method yields an improved outcome. Seven first complete-remission (CR) (CR1), 45 second- or third-CR (CR2/3), and 11 first-relapse (R1) patients were treated with chemotherapy and TBI or chemotherapy alone followed by ABMT with MoAb-purged BM. Median age at ABMT for those patients in CR 2/3 and R1 patients was 36 years. Twenty-nine CR 2/3 and R1 patients were conditioned with Cy/fTBI, and 27 CR2/3 and R1 patients were conditioned with Bu/CY. Using the Kaplan-Meier method, the CY/fTBI, CR2/3, and R1 patients have a 3-year disease-free survival (DFS) of 21%. On the other hand, the Bu/Cy2, CR2/3, and R1 patients have a 3-year DFS of 48%. Nineteen CR2/3 and R1 patients relapsed post-ABMT. On analysis by conditioning regimen, those treated with Cy/fTBI have a 3-year relapse rate (RR) of 58%, whereas the patients conditioned with Bu/Cy2 have a 39% 3-year RR. Long-term DFS can be achieved in about 50% of patients with advanced remissions and relapsed AML using Bu/Cy2 with MoAb-purged BM.

subject areas

  • Adolescent
  • Adult
  • Antibodies, Monoclonal
  • Bone Marrow Purging
  • Bone Marrow Transplantation
  • Child
  • Female
  • Hematopoietic Stem Cells
  • Humans
  • Leukemia, Myeloid, Acute
  • Male
  • Middle Aged
  • Recurrence
  • Survival Rate
  • Transplantation, Autologous
  • Whole-Body Irradiation
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Identity

International Standard Serial Number (ISSN)

  • 0006-4971

PubMed ID

  • 8123862
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Additional Document Info

start page

  • 1698

end page

  • 1705

volume

  • 83

issue

  • 6

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