BONE-MARROW TRANSPLANTATION FOR ACUTE NONLYMPHOCYTIC LEUKEMIA IN 1ST REMISSION - ANALYSIS OF PROGNOSTIC FACTORS

  • 1 January 1985
    • journal article
    • research article
    • Vol. 65  (5) , 1191-1196
Abstract
Prognostic factors were reviewed retrospectively for 39 children and adults aged 1-40 yr (median 14 yr) with acute nonlymphocytic leukemia (ANLL) who attained a 1st remission and underwent bone marrow transplantation. The preparation regimen for transplantation was cyclophosphamide (60 mg/kg per d [day] for 2 followed by total body irradiation (either 750 cGY [antigrays] single dose at 26 cGy/min, n = 37, or 1320 cGy fractionated at 10 cGy/min, n = 2). Twenty-three patients are surviving disease free with a median follow-up of 3 yr. The 3 yr estimated disease-free survival is 55% .+-. 17% (.+-. 2 SE). Five patients have relapsed from 92-756 days after transplantation for an estimated relapse rate of 21% .+-. 18%. Two factors, the white blood cell (WBC) count and the French-American-British (FAB) classification at leukemia diagnosis were found to be of prognostic importance. Patients with a WBC of < 20,000/.mu.l at diagnosis had a 3 yr estimated disease-free survival of 74% .+-. 18% vs. 26% .+-. 24% for those with a WBC of .gtoreq. 20,000 (P = 0.008). The estimated relapse rate was 6% .+-. 12% for patients with a WBC at diagnosis < 20,000 vs. 53% .+-. 38% for patients with a WBC at diagnosis of .gtoreq. 20,000 (P = 0.01). Patients with myeloid morphology at diagnosis (FAB M1,2,3,) had an estimated relapse rate of 9% .+-. 12% vs. patients with monocytoid morphology (FAB M4,5a) whose estimated relapse rate was 58% .+-. 44% (P = 0.05). A high WBC count at diagnosis and monocytoid morphology (FAB M4,5a) apparently are poor prognostic factors for patients with ANLL who undergo bone marrow transplantation in 1st remission after conditioning with cyclophosphamide plus total body irradiation.