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Bone marrow transplantation in acute leukemia.

U W Schaefer, D W Beelen, H K Mahmoud

    Haematology and Blood Transfusion
    |January 1, 1987
    PubMed
    Summary

    Bone marrow transplants in Essen showed improved survival for acute myeloid leukemia (AML) patients in remission (55%) and acute lymphoblastic leukemia (ALL) patients (50%). Graft-versus-host disease (GvHD) and interstitial pneumonia remain significant challenges.

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    Area of Science:

    • Hematology
    • Oncology
    • Immunology

    Background:

    • Bone marrow transplantation (BMT) is a critical treatment for hematologic malignancies and aplastic anemia.
    • Early BMT protocols faced challenges with graft-versus-host disease (GvHD) and opportunistic infections like cytomegalovirus (CMV).
    • Strict gnotobiotic care and prophylactic measures were implemented to improve patient outcomes.

    Purpose of the Study:

    • To evaluate the outcomes of 142 bone marrow transplantations performed between 1975 and 1985.
    • To assess the efficacy of cyclophosphamide-based conditioning regimens and GvHD prophylaxis.
    • To analyze the incidence of GvHD and interstitial pneumonia in various hematologic conditions.

    Main Methods:

    • Conducted 142 bone marrow transplantations, with 74 cases involving acute leukemia.

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  • Utilized cyclophosphamide or cyclophosphamide with total body irradiation for conditioning.
  • Administered intravenous CMV-hyperimmune globulin and CMV-negative blood products, with methotrexate for GvHD prophylaxis.
  • Maintained patients under strict gnotobiotic conditions.

    • Main Results:

    • Long-term survival was poor for acute leukemia in relapse (1/23).
    • Survival rates were 55% for AML patients in first remission and 50% for ALL patients in remission.
    • GvHD incidence varied: 28% in aplastic anemia, 26% in AML, 9% in ALL, and 63% in CML.
    • Fatal interstitial pneumonia occurred in 34% of leukemia patients, but none in aplastic anemia patients.

    Conclusions:

    • BMT in first remission offers significant survival benefits for AML and ALL patients.
    • GvHD and interstitial pneumonia remain critical complications post-transplantation, particularly in leukemia.
    • Continued research into GvHD and infection prophylaxis is essential for improving BMT outcomes.