Factors affecting the outcome of allogeneic bone marrow transplantation for adult patients with refractory or relapsed acute leukaemia

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Abstract
We evaluated the outcome of allogeneic bone marrow transplantation (BMT) for advanced acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL) in 383 adult patients in nine Australian adult BMT centres between 1981 and 1997. The median overall survival for the group was 4.8 months, with an estimated 5‐year survival of 18%. 28% of patients died of transplant‐related toxicities within the first 100 d. Progressive disease was responsible for 48% of deaths. Multi‐factor analysis demonstrated that AML (v ALL), disease status (second complete remission [CR2] v others), age (< 40 years) and duration of prior first complete remission (CR1) (> 6 months) were pre‐transplant variables significantly associated with improved survival. Acute graft‐versus‐host disease (GVHD) of any grade reduced the rate of relapse in both AML and ALL, but only grades I–II were associated with improved survival. Both limited and extensive chronic GVHD were associated with increased survival. Only patients with AML in untreated first relapse or CR2, with a duration of CR1 > 6 months, or patients with T ALL, had a 5‐year survival > 20%. Transplants for AML in induction failure or pre‐B ALL in untreated first relapse or CR2 had an intermediate outcome, with 5‐year survival of 10–20%. A 5‐year survival of < 10% was observed for patients transplanted for ALL in induction failure or for pre‐B ALL or AML in refractory first relapse or beyond CR2. These results suggest that for most adult patients with advanced acute leukaemia an allograft offers only a small chance of cure.