The Role of Allogeneic Bone Marrow Transplantation in Tatients with Acute Leukemia during First Remission

Abstract

We compared the outcome of bone marrow transplantation with that of continued chemotherapy for acute leukemia who achieved a first remission. From August 1981 to December 1986, 141 consecutive patients (ages 9 to 77 years) with acute leukemia were treated with induction chemotherapy. One hundred and four patients (74%) entered a complete remission. Of those, 42 patients were under the age of forty years. Sixteen remission patients had HLA-matched siblings. Eleven of them received bone marrow transplantation (BMT group) and five did not (BMT refusal group). Twenty six patients in remission without matched siblings were treated with continued chemotherapy (chemotherapy group).
Kaplan-Meier estimates of 4-year disease free survival from complete remission were 73% for the transplanted group and 14% for the chemotherapy group. Within the transplant group, three partients died during the first six months and eight patients were alive in complete remission. All of the BMT refusal group relapsed within eight months. In the chemotherapy group, 22 of 26 patients relapsed and/or died during 16 months.
Among the transplant group, ages under 25 years and the presence of acute GVHD grade I were associated with better prognosis. In the continued chemotherapy group, high initial leukocyte counts were related to poor prognosis.