Twenty-five Patients with Acute Leukemia Treated by Bone Marrow Transplantation

Abstract

Consecutive twenty-five patients with acute leukemia including 10 with acute lymphoblastic leukemia (ALL), 12 with acute non-lymphocytic leukemia (ANL) and 3 with leukemic non-Hodgkin's lymphoma were treated with high-dose cyclophosphamide and 10 Gy total body irradiation followed by bone marrow transplantation from 23 HLA-identical and one HLA-mismatched sibling donors and one identical twin donor. The patients ranged from 9 to 46 yr in age (the median, 31 yr). Eleven patients were transplanted at relapse and 14 during complete remission. At the time of analysis (January 15, 1985), 6 transplant patients are alive in unmaintained remission 80, 46, 32, 25, 14 and 9 mo respectively posttransplant. Another patient developed relapse and is now surviving in partial remission 14 mo after transplantation. Primary causes of death in 18 patients were as follows: Interstitial pneumonia in 8 patients, leukemic relapse in 4, hepatic veno-occlusive disease in 2, sepsis in 2, acute GVHD in 1 and chronic GVHD associated with pneumonia in 1. When results were analysed in relation to 1 yr survival, factors such as patient's age, donor's age, type of acute leukemia and clinical condition at transplantation were associated with the survival. The younger age of the patients and transplantation during remission are two favorable factors. These are also important factors affecting early death. Among transplantation-related complications, interstitial pneumonia is one of the most important problems to be solved because it was closely associated with early death. Both acute and chronic GVHD had no effect on early death or 1 yr survival. These observations suggest that long-term survival will be highly expected in younger patients with acute leukemia when bone marrow transplantation is performed during remission.