Journal of Clinical Oncology, Vol 10, 237-242, Copyright © 1992 by American Society of Clinical Oncology
Radiation-free preparation for allogeneic bone marrow transplantation in adults with acute lymphoblastic leukemia
EA Copelan, JC Biggs, BR Avalos, J Szer, I Cunningham, JP Klein, K Atkinson, N Kapoor, JL Klein and K Downs
Department of Internal Medicine, Ohio State University, Columbus 43210.
PURPOSE: The study was undertaken to investigate the effectiveness of
allogeneic bone marrow transplantation from HLA-identical siblings after
preparation with busulfan and cyclophosphamide in adults with acute
lymphoblastic leukemia (ALL). PATIENTS AND METHODS: Thirty-nine patients
aged 15 to 42 years underwent transplantation at three different centers
from November 1984 through November 1990. All patients received 16 mg/kg
busulfan and 120 mg/kg cyclophosphamide as preparative therapy.
Cyclosporine plus methotrexate or cyclosporine plus corticosteroids with or
without methotrexate were given for prevention of graft-versus-host disease
(GVHD). RESULTS: Twelve patients died of treatment-related complications,
12 patients relapsed, and 15 patients are leukemia-free survivors. For 27
patients in group 1 (first remission, second remission, first relapse), the
estimated leukemia-free survival (LFS) rate is 42.3% (95% confidence
interval [CI], 22.9% to 71.7%) at 3 years. For 12 patients with more
advanced disease (group 2), the 1-year LFS rate is 13.5% (95% CI, 0% to
37.1%). Chronic GVHD occurred at an estimated incidence of 63.3% and
developed significantly more frequently among patients who received
corticosteroids for prevention of acute GVHD. Chronic GVHD was associated
with a significantly lower incidence of relapse and with improved LFS
rates. CONCLUSION: LFS rate in this study is comparable to that obtained
with radiation-containing regimens; however, the effectiveness of this
preparative regimen in ALL requires further study.
