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Bone Marrow Transplantation or Chemotherapy After Remission Induction for Adults with Acute Nonlymphoblastic Leukemia

1984; American College of Physicians; Volume: 101; Issue: 5 Linguagem: Inglês

10.7326/0003-4819-101-5-581

1539-3704

FR Appelbaum, S Dahlberg, Thomas Ed, Buckner Cd, MA Cheever, Clift Ra, John Crowley, Deeg Hj, A Fefer, Greenberg Pd,

Acute Lymphoblastic Leukemia research

We compared the outcome of marrow transplantation with that of continued chemotherapy for adults with acute nonlymphoblastic leukemia who achieve a first remission. From May 1977 to July 1982, 111 consecutive adults (ages 17 to 50) with newly diagnosed acute nonlymphoblastic leukemia were treated with induction chemotherapy. Ninety patients (81%) had a complete remission. Forty-four remission patients had available donors: 33 received a transplant and 11 did not. Forty-six patients in remission without matched donors were treated with continued chemotherapy. Kaplan-Meier estimates of 5-year, disease-free survival from complete remission are 49% ± 18% for the transplant group and 20% ± 13% for the chemotherapy group. When compared to the chemotherapy group, patients undergoing transplantation had a higher risk of dying during the first 6 months after remission induction but a lower risk of dying thereafter. Within the transplant group, only age influenced survival. Within the chemotherapy group, a leukocyte count of greater than 10 000 mm3 at diagnosis, a French-American-British (FAB) Cooperative Group morphologic status of M-4, M-5, or M-6, and the presence of infection at diagnosis were all associated with shorter survival.