Chemotherapy Compared with Autologous or Allogeneic Bone Marrow Transplantation in the Management of Acute Myeloid Leukemia in First Remission
Peter A. Cassileth, M.D., David P. Harrington, Ph.D., Frederick R. Appelbaum, M.D., Hillard M. Lazarus, M.D., Jacob M. Rowe, M.D., Elisabeth Paietta, Ph.D., Cheryl Willman, M.D., David D. Hurd, M.D., John M. Bennett, M.D., Karl G. Blume, M.D., David R. Head, M.D., and Peter H. Wiernik, M.D.
Background In young adults with acute myeloid leukemia, intensivechemotherapy during the initial remission improves the long-termoutcome, but the role of bone marrow transplantation is uncertain.We compared high-dose cytarabine with autologous or allogeneicmarrow transplantation during the first remission of acute myeloidleukemia.
Methods Previously untreated adolescents and adults 16 to 55years of age who had acute myeloid leukemia received standardinduction chemotherapy. After complete remission had been achieved,idarubicin (two days) and cytarabine (five days) were administered.Patients with histocompatible siblings were offered allogeneicmarrow transplantation, whereas the remaining patients wererandomly assigned to receive a single course of high-dose cytarabineor transplantation of autologous marrow treated with perfosfamide(4-hydroperoxycyclophosphamide). Oral busulfan and intravenouscyclophosphamide were used as preparative regimens for bothallogeneic and autologous marrow transplantation. The end pointswere survival from the time of complete remission and disease-freesurvival.
Results In an intention-to-treat analysis, we found no significantdifferences in disease-free survival among patients receivinghigh-dose chemotherapy, those undergoing autologous bone marrowtransplantation, and those undergoing allogeneic marrow transplantation.The median follow-up was four years. Survival after completeremission was somewhat better after chemotherapy than afterautologous marrow transplantation (P=0.05). There was a marginaladvantage in terms of overall survival with chemotherapy ascompared with allogeneic marrow transplantation (P=0.04).
Conclusions A postinduction course of high-dose cytarabine canprovide equivalent disease-free survival and somewhat betteroverall survival than autologous marrow transplantation in adultswith acute myeloid leukemia.
Source Information
From the University of Miami Sylvester Comprehensive Cancer Center, Miami (P.A.C.); Dana–Farber Cancer Institute and Harvard School of Public Health, Boston (D.P.H.); Fred Hutchinson Cancer Research Center, Seattle (F.R.A.); Case Western Reserve University School of Medicine, Cleveland (H.M.L.); University of Rochester Cancer Center, Rochester, N.Y. (J.M.R., J.M.B.); Albert Einstein Cancer Center at Montefiore Medical Center, Bronx, N.Y. (E.P., P.H.W.); University of New Mexico School of Medicine, Albuquerque (C.W.); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, N.C. (D.D.H.); Stanford University Hospital, Stanford, Calif. (K.G.B.); and St. Jude Children's Research Hospital, Memphis, Tenn. (D.R.H.).
Address reprint requests to Dr. Cassileth at the Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave., Miami, FL 33136.
Treatment of Acute Myeloid Leukemia
Kanda Y., Miwa A., Togawa A., Perez-Calvo J., Brugarolas A., Suzuki R., Seto M., Morishima Y., Gorin N.-C., Labopin M., Woods W. G., Sanders J. E., Neudorf S., Cassileth P. A., Appelbaum F. R., Wiernik P. H., Burnett A. K.
Extract |
Full Text
N Engl J Med 1999;
340:1436-1439, May 6, 1999.
Correspondence
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