Journal of Clinical Oncology, Vol 10, 1865-1869, Copyright © 1992 by American Society of Clinical Oncology
Improvement in outcome for children receiving allogeneic bone marrow transplantation in first remission of acute myeloid leukemia: a report from the Groupe d'Etude des Greffes de Moelle Osseuse
G Michel, E Gluckman, D Blaise, H Esperou-Bourdeau, JP Vernant, M Kuentz, P Bordigoni, N Milpied, H Rubie and I Thuret
Institut Paoli-Calmettes, Marseille, France.
PURPOSE: We retrospectively analyzed the outcome of children with acute
myeloid leukemia (AML) in first complete remission (CR) who received
HLA-identical bone marrow transplantation (BMT) in 13 French transplant
centers. PATIENTS AND METHODS: Seventy-four children were treated from June
1979 through December 1990. The conditioning regimen included total-body
irradiation (TBI) in 54 cases and busulfan in 20. Prophylaxis of
graft-versus-host disease (GVHD) consisted of cyclosporine (CycloA) plus
methotrexate (MTX) for 38 patients, MTX for 17, CycloA for 18, and T
depletion without other prophylaxis for one. The mean value of the interval
from diagnosis to transplantation was 167 days. RESULTS: Sixteen patients
died of transplant-related complications, 12 relapsed, and 46 are alive in
continuous remission with a median follow-up of 46 months. We examined
results obtained over three successive periods: 1979 to 1982 (n = 14
children), 1983 to 1986 (n = 29), and 1987 to 1990 (n = 31). Probabilities
of event-free survival (EFS) were 43%, 48%, and 82% for the three
successive periods, respectively (P < .02). This improvement in EFS was
linked to a decreased risk of transplant-related mortality: 36%, 36%, and
3%, respectively (P < .01). Other factors associated with a better EFS
in the univariate analysis were a short time interval from diagnosis to
transplant (< 120 days), the absence of significant (grade > or = 2)
acute GVHD, and the absence of chronic GVHD. In the multivariate analysis,
two factors had a favorable impact on long-term survival: the year of
transplantation (years 1987 to 1990 v others) and the absence of acute
GVHD. CONCLUSION: The outcome for children receiving allogeneic BMT in
first CR of AML has improved in France during recent years.
