engleski

Allogeneic Stem Cell Transplantation for the Treatment of AML Patients – A Single Center Retrospecitve Analysis for 10 Years Period (1994. – 2003.)

Allogeneic stem cell transplantation is a standard treatment approach for younger AML patients having an HLA identical donor (except acute promyelocytic leukemia patients). The experience of Zagreb transplant center in 10 years period (1994.-2003) is presented. Patient and methods: 53 AML patients, (23 male and 30 female), median age of 32 years (2-51) having an HLA identical donor underwent allogeneic stem cell transplantation. All of the patients received induction and consolidation therapy according to the EORTC protocols for the treatment of acute myeloid leukemia ( EORTC No 06931 and No 06991).In 42 out of 53 (79.2 %) patients allogeneic transplantation was has been performed in first complete remission (1st CR) and 11 patients (20.8%) were transplanted in advanced phase of the disease. 49 patients (92, 4%) received the conditioning regimen consisted of busulfan 16 mg/kg body weight in 16 doses and cyclophosphamide 120 mg/kg body weight during two days and 4 patients recived total body irradiation and cyclophosphamide. Cyclosporine and short courses of methotrexate were given for GvHD prophylaxis. Results: The probability of 5 year overall survival for patients transplanted in 1st CR is 61.3%, with a median of 19.5 months (1-116 months), while the probability of OS for patients who received stem cell transplant in advanced phase of the disease was 18.2%, with median of 7 months (2-109 months), p=0.0008. Disease free survival (DFS) for the AML patients transplanted in 1st CR was 59.9%, with a median of 16.5 months (1-116 months) vs. 18.2%, median 4 months (2-109 months) for patients in >1st CR, (p=0.0004). Relapse rates for patients in 1st CR were 25.3% compared to 59.1% (p=NS) for the other group. Time to relapse for patients transplanted in 1st CR ranged from 7-67 months (median 20.5 months), while for those transplanted in more advanced phase was 2-13 months, with median of 3.50 months Transplant related mortality (TRM) was also lower for patients in 1st CR than for those transplanted in advanced phase of the disease, 45.6% vs. 18.3% (p=0.056). Conclusion: Allogeneic stem cell transplantation is a standard post-remission treatment for AML patients offering significantly longer overall survival and disease free survival with lower transplant related mortality and lower relapse rate when performed in first complete remission than in more advanced phases of the disease.

Acute myeloid leukemia; Transplantation

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