Unrelated donor marrow transplantation for acute myeloid leukemia: an update of the Seattle experience

Abstract

Between 1985 and 1998, 161 patients with primary acute myeloid leukemia (AML) received T-replete bone marrow transplantation (BMT) from unrelated donors in Seattle. Median age was 30 (range 1–55) years. Conditioning for BMT consisted of cyclophosphamide and total body irradiation in 154 (96%) cases and graft-versus-host disease prophylaxis was the standard methotrexate and cyclosporine combination in 134 (83%) cases. Median post-transplant follow-up was 2.9 years. Leukemia-free survival (LFS) at 5 years was 50 ± 12% for transplants during first complete remission (n = 16), 28 ± 8% during second CR (n = 40), 27 ± 17% during subsequent CR (n = 8), 7 ± 3% during relapse (n = 81) and 19 ± 10% during primary induction failure (n = 16). The cumulative incidences of relapse were 19%, 23%, 25%, 44% and 63%, for the five groups, respectively. Transplantation during remission, a marrow cell dose above 3.5 × 10⁸/kg, and cytomegalovirus seronegative status before BMT in both patient and donor were favorable prognostic factors. Adults in any CR who received a marrow cell dose above 3.5 × 10⁸/mg had a LFS of 54 ± 9% at 5 years. These data extend our previous findings on the association between a high marrow cell dose and improved survival and support the use of unrelated donor BMT for treatment of patients with high risk AML when a family match is not available. Bone Marrow Transplantation (2000) 26, 397–404.