Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purging for acute myeloid leukaemia beyond first remission: A 10-year experience

B Douglas Smith, Richard J Jones, Shing M. Lee, Steve Piantadosi, Milada S. Vala, Don Fuller, Steven D. Gore, Steven J. Noga, Paul V. O'Donnell, Hayden Braine, Georgia Boyce Vogelsang, Ephraim J Fuchs, Ian W. Flinn, Robert A Brodsky, Richard F Ambinder, Carole B. Miller

Research output: Contribution to journalArticle

Abstract

Between January 1987 and January 1997, 69 eligible patients with acute myeloid leukaemia (AML) in either second (CR2) or third (CR3) complete remission (CR2 = 60, CR3 = 9) underwent 4-hydroperoxycyclophosphamide-purged autologous bone marrow transplantation (BMT) at the Johns Hopkins Oncology Center. The patients' median age was 27 years (range 1-62) and all received busulphan and cyclophosphamide as their preparative regimen. The probability of event-free survival (EFS) at 5 years was 30% [95% Confidence Interval (CI): 19-42%] for CR2 patients and 22% (3-51%) for those in CR3, with a median follow up of 8 years in the surviving group. The median time to an absolute neutrophil count of 0.5 × 109/l was 45 d (range 20-185). Relapse was the major cause of failure with a relapse rate of 55% in CR2 and 44% in CR3, while the non-relapse, transplant-related mortality rate was 15% in CR2 and 33% in CR3. In univariate analysis, patient age, cytogenetics, white blood cell count at presentation, CR1 duration and the sensitivity of clonogeneic leukaemia (CFU-L) in the graft to 4HC were all prognostic for EFS. Using each of these significant variables in multivariate modelling, patient age and sensitivity of CFU-L to 4HC were determined to be predictors of EFS. 4HC-purged autologous BMT produced results similar to allogeneic BMT for AML patients beyond first remission.

Original languageEnglish (US)
Pages (from-to)907-913
Number of pages7
JournalBritish Journal of Haematology
Volume117
Issue number4
DOIs
StatePublished - 2002

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perfosfamide
Autologous Transplantation
antineoplaston A10
Bone Marrow Transplantation
Acute Myeloid Leukemia
Disease-Free Survival
Transplants
Recurrence
Busulfan
Homologous Transplantation
Leukocyte Count
Cytogenetics
Cyclophosphamide
Leukemia
Neutrophils

Keywords

  • 4HC
  • Acute myeloid leukaemia (AML)
  • Autologous BMT
  • Purging

ASJC Scopus subject areas

  • Hematology

Cite this

Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purging for acute myeloid leukaemia beyond first remission : A 10-year experience. / Smith, B Douglas; Jones, Richard J; Lee, Shing M.; Piantadosi, Steve; Vala, Milada S.; Fuller, Don; Gore, Steven D.; Noga, Steven J.; O'Donnell, Paul V.; Braine, Hayden; Vogelsang, Georgia Boyce; Fuchs, Ephraim J; Flinn, Ian W.; Brodsky, Robert A; Ambinder, Richard F; Miller, Carole B.

In: British Journal of Haematology, Vol. 117, No. 4, 2002, p. 907-913.

Research output: Contribution to journalArticle

Smith, B Douglas ; Jones, Richard J ; Lee, Shing M. ; Piantadosi, Steve ; Vala, Milada S. ; Fuller, Don ; Gore, Steven D. ; Noga, Steven J. ; O'Donnell, Paul V. ; Braine, Hayden ; Vogelsang, Georgia Boyce ; Fuchs, Ephraim J ; Flinn, Ian W. ; Brodsky, Robert A ; Ambinder, Richard F ; Miller, Carole B. / Autologous bone marrow transplantation with 4-hydroperoxycyclophosphamide purging for acute myeloid leukaemia beyond first remission : A 10-year experience. In: British Journal of Haematology. 2002 ; Vol. 117, No. 4. pp. 907-913.
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abstract = "Between January 1987 and January 1997, 69 eligible patients with acute myeloid leukaemia (AML) in either second (CR2) or third (CR3) complete remission (CR2 = 60, CR3 = 9) underwent 4-hydroperoxycyclophosphamide-purged autologous bone marrow transplantation (BMT) at the Johns Hopkins Oncology Center. The patients' median age was 27 years (range 1-62) and all received busulphan and cyclophosphamide as their preparative regimen. The probability of event-free survival (EFS) at 5 years was 30{\%} [95{\%} Confidence Interval (CI): 19-42{\%}] for CR2 patients and 22{\%} (3-51{\%}) for those in CR3, with a median follow up of 8 years in the surviving group. The median time to an absolute neutrophil count of 0.5 × 109/l was 45 d (range 20-185). Relapse was the major cause of failure with a relapse rate of 55{\%} in CR2 and 44{\%} in CR3, while the non-relapse, transplant-related mortality rate was 15{\%} in CR2 and 33{\%} in CR3. In univariate analysis, patient age, cytogenetics, white blood cell count at presentation, CR1 duration and the sensitivity of clonogeneic leukaemia (CFU-L) in the graft to 4HC were all prognostic for EFS. Using each of these significant variables in multivariate modelling, patient age and sensitivity of CFU-L to 4HC were determined to be predictors of EFS. 4HC-purged autologous BMT produced results similar to allogeneic BMT for AML patients beyond first remission.",
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AU - Smith, B Douglas

AU - Jones, Richard J

AU - Lee, Shing M.

AU - Piantadosi, Steve

AU - Vala, Milada S.

AU - Fuller, Don

AU - Gore, Steven D.

AU - Noga, Steven J.

AU - O'Donnell, Paul V.

AU - Braine, Hayden

AU - Vogelsang, Georgia Boyce

AU - Fuchs, Ephraim J

AU - Flinn, Ian W.

AU - Brodsky, Robert A

AU - Ambinder, Richard F

AU - Miller, Carole B.

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N2 - Between January 1987 and January 1997, 69 eligible patients with acute myeloid leukaemia (AML) in either second (CR2) or third (CR3) complete remission (CR2 = 60, CR3 = 9) underwent 4-hydroperoxycyclophosphamide-purged autologous bone marrow transplantation (BMT) at the Johns Hopkins Oncology Center. The patients' median age was 27 years (range 1-62) and all received busulphan and cyclophosphamide as their preparative regimen. The probability of event-free survival (EFS) at 5 years was 30% [95% Confidence Interval (CI): 19-42%] for CR2 patients and 22% (3-51%) for those in CR3, with a median follow up of 8 years in the surviving group. The median time to an absolute neutrophil count of 0.5 × 109/l was 45 d (range 20-185). Relapse was the major cause of failure with a relapse rate of 55% in CR2 and 44% in CR3, while the non-relapse, transplant-related mortality rate was 15% in CR2 and 33% in CR3. In univariate analysis, patient age, cytogenetics, white blood cell count at presentation, CR1 duration and the sensitivity of clonogeneic leukaemia (CFU-L) in the graft to 4HC were all prognostic for EFS. Using each of these significant variables in multivariate modelling, patient age and sensitivity of CFU-L to 4HC were determined to be predictors of EFS. 4HC-purged autologous BMT produced results similar to allogeneic BMT for AML patients beyond first remission.

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