Marrow Transplantation for Acute Nonlymphocytic Leukemia after Treatment with Busulfan and Cyclophosphamide

TLDR

Patients with acute non‑lymphocytic leukemia received HLA‑identical sibling marrow after high‑dose busulfan and cyclophosphamide cytoreduction. Two‑year survival rates were 0 %, 29 %, and 44 % for end‑stage, second/third remission, and first remission patients, respectively; 12 patients remained in remission after 327–1488 days, with 10 surviving beyond two years, and survival was better in younger patients and those transplanted during first remission. N Engl J Med 1983: 309:1347–53.

Abstract

Fifty-one patients with acute nonlymphocytic leukemia (16 with end-stage disease, 17 in second or third remission or in early relapse, and 18 in first remission) were given infusions of HLA-identical sibling marrow after cytoreduction with high doses of busulfan and cyclophosphamide. Actuarial two-year survival rates were 0 per cent, 29 per cent, and 44 per cent, respectively. Twelve patients are still alive and in remission after 327 to 1488 days, with 10 surviving beyond two years. Acute graft-versus-host disease and viral pneumonia were the major causes of death. Leukemic cells failed to clear in one patient with end-stage disease, and a relapse with meningeal leukemia occurred in another. Only one other relapse was seen — in a patient given a transplant during a third remission. Survival was favorably affected by younger age and transplantation during first remission. We conclude that high-dose chemotherapy with busulfan and cyclophosphamide, followed by allogeneic-marrow transplantation, can produce long-term remission of acute leukemia. Chemotherapy with high-dose busulfan and cyclophosphamide before transplantation provides an effective alternative to cyclophosphamide and total-body irradiation before transplantation for the treatment of acute nonlymphocytic leukemia. (N Engl J Med 1983: 309:1347–53.)