Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia

R. B. Geller, R. Saral, S. Piantadosi, M. Zahurak, G. B. Vogelsang, J. R. Wingard, R. F. Ambinder, W. B. Beschorner, H. G. Braine, W. H. Burns, A. D. Hess, R. J. Jones, W. Stratford May, S. D. Rowley, J. E. Wagner, Andrew M Yeager, G. W. Santos

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Abstract

Ninety-nine patients with acute nonlymphocytic leukemia (ANLL) received HLA-identical bone marrow transplants (BMTs) from sibling donors after preparation with high doses of busulfan and cyclophosphamide. Forty-nine patients were transplanted in first complete remission (CR), and 50 patients were transplanted in second and third CR and early relapse. Fifty-three recieved one of three regimens containing primarily low-dose cyclophosphamide (group I) for graft-v-host disease (GVHD) prophylaxis; since March 1983, 46 patients received intravenous (IV) cyclosporine (group II). After December 1983, only cytomegalovirus (CMV)-seronegative blood products were used in appropriate patients, and since April 1984 patients seropositive for herpes-simplex virus (HSV) and CMV received high-dose acyclovir prophylaxis. For patients transplanted in first CR, there was a significantly lower incidence of acute GVHD (P = .005) and deaths related to GVHD and interstitial pneumonitis (P = .001) in patients in group II. This was reflected in an improved Kaplan-Meier probability of disease-free survival (DFS) in the 22 patients transplanted in group II as compared with the 27 patients in group I (64% ± 10% v 30% ± 9%, P = .017). The probability of remaining in remission was slightly lower in group II (82% ± 9% v 94% ± 6%, P = .479). For patients transplanted in second and third CR and early relapse, the incidence of acute GVHD (P = .026) and deaths related to GVHD and interstitial pneumonitis was significantly lower in group II (P = .029); the probability of remaining in remission was also less (47% ± 15% v 91% ± 15%, P = .022). However, the probability of DFS was not significantly different between the two groups (26% ± 10% v 35% ± 18%, P = .957). We conclude that transplantation for patients in first CR who received IV cyclosporine therapy is effective treatment; patients with more refractory disease treated with the same cyclosporine regimen (group II) had a lower incidence of GVHD than those treated in group I, but survival did not improve because of an increase in the number of relapses and other nonleukemic complications.

Original languageEnglish (US)
Pages (from-to)2209-2218
Number of pages10
JournalBlood
Volume73
Issue number8
StatePublished - 1989
Externally publishedYes

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Busulfan
Homologous Transplantation
Bone Marrow Transplantation
Acute Myeloid Leukemia
Cyclophosphamide
Bone
Grafts
Transplants
Cyclosporine
Interstitial Lung Diseases
Cytomegalovirus
Recurrence
Disease-Free Survival
Acyclovir
Incidence
Viruses
Refractory materials
Blood
Simplexvirus
Siblings

ASJC Scopus subject areas

  • Hematology

Cite this

Geller, R. B., Saral, R., Piantadosi, S., Zahurak, M., Vogelsang, G. B., Wingard, J. R., ... Santos, G. W. (1989). Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia. Blood, 73(8), 2209-2218.

Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia. / Geller, R. B.; Saral, R.; Piantadosi, S.; Zahurak, M.; Vogelsang, G. B.; Wingard, J. R.; Ambinder, R. F.; Beschorner, W. B.; Braine, H. G.; Burns, W. H.; Hess, A. D.; Jones, R. J.; Stratford May, W.; Rowley, S. D.; Wagner, J. E.; Yeager, Andrew M; Santos, G. W.

In: Blood, Vol. 73, No. 8, 1989, p. 2209-2218.

Research output: Contribution to journalArticle

Geller, RB, Saral, R, Piantadosi, S, Zahurak, M, Vogelsang, GB, Wingard, JR, Ambinder, RF, Beschorner, WB, Braine, HG, Burns, WH, Hess, AD, Jones, RJ, Stratford May, W, Rowley, SD, Wagner, JE, Yeager, AM & Santos, GW 1989, 'Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia', Blood, vol. 73, no. 8, pp. 2209-2218.
Geller RB, Saral R, Piantadosi S, Zahurak M, Vogelsang GB, Wingard JR et al. Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia. Blood. 1989;73(8):2209-2218.
Geller, R. B. ; Saral, R. ; Piantadosi, S. ; Zahurak, M. ; Vogelsang, G. B. ; Wingard, J. R. ; Ambinder, R. F. ; Beschorner, W. B. ; Braine, H. G. ; Burns, W. H. ; Hess, A. D. ; Jones, R. J. ; Stratford May, W. ; Rowley, S. D. ; Wagner, J. E. ; Yeager, Andrew M ; Santos, G. W. / Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia. In: Blood. 1989 ; Vol. 73, No. 8. pp. 2209-2218.
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abstract = "Ninety-nine patients with acute nonlymphocytic leukemia (ANLL) received HLA-identical bone marrow transplants (BMTs) from sibling donors after preparation with high doses of busulfan and cyclophosphamide. Forty-nine patients were transplanted in first complete remission (CR), and 50 patients were transplanted in second and third CR and early relapse. Fifty-three recieved one of three regimens containing primarily low-dose cyclophosphamide (group I) for graft-v-host disease (GVHD) prophylaxis; since March 1983, 46 patients received intravenous (IV) cyclosporine (group II). After December 1983, only cytomegalovirus (CMV)-seronegative blood products were used in appropriate patients, and since April 1984 patients seropositive for herpes-simplex virus (HSV) and CMV received high-dose acyclovir prophylaxis. For patients transplanted in first CR, there was a significantly lower incidence of acute GVHD (P = .005) and deaths related to GVHD and interstitial pneumonitis (P = .001) in patients in group II. This was reflected in an improved Kaplan-Meier probability of disease-free survival (DFS) in the 22 patients transplanted in group II as compared with the 27 patients in group I (64{\%} ± 10{\%} v 30{\%} ± 9{\%}, P = .017). The probability of remaining in remission was slightly lower in group II (82{\%} ± 9{\%} v 94{\%} ± 6{\%}, P = .479). For patients transplanted in second and third CR and early relapse, the incidence of acute GVHD (P = .026) and deaths related to GVHD and interstitial pneumonitis was significantly lower in group II (P = .029); the probability of remaining in remission was also less (47{\%} ± 15{\%} v 91{\%} ± 15{\%}, P = .022). However, the probability of DFS was not significantly different between the two groups (26{\%} ± 10{\%} v 35{\%} ± 18{\%}, P = .957). We conclude that transplantation for patients in first CR who received IV cyclosporine therapy is effective treatment; patients with more refractory disease treated with the same cyclosporine regimen (group II) had a lower incidence of GVHD than those treated in group I, but survival did not improve because of an increase in the number of relapses and other nonleukemic complications.",
author = "Geller, {R. B.} and R. Saral and S. Piantadosi and M. Zahurak and Vogelsang, {G. B.} and Wingard, {J. R.} and Ambinder, {R. F.} and Beschorner, {W. B.} and Braine, {H. G.} and Burns, {W. H.} and Hess, {A. D.} and Jones, {R. J.} and {Stratford May}, W. and Rowley, {S. D.} and Wagner, {J. E.} and Yeager, {Andrew M} and Santos, {G. W.}",
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T1 - Allogeneic bone marrow transplantation after high-dose busulfan and cyclophosphamide in patients with acute nonlymphocytic leukemia

AU - Geller, R. B.

AU - Saral, R.

AU - Piantadosi, S.

AU - Zahurak, M.

AU - Vogelsang, G. B.

AU - Wingard, J. R.

AU - Ambinder, R. F.

AU - Beschorner, W. B.

AU - Braine, H. G.

AU - Burns, W. H.

AU - Hess, A. D.

AU - Jones, R. J.

AU - Stratford May, W.

AU - Rowley, S. D.

AU - Wagner, J. E.

AU - Yeager, Andrew M

AU - Santos, G. W.

PY - 1989

Y1 - 1989

N2 - Ninety-nine patients with acute nonlymphocytic leukemia (ANLL) received HLA-identical bone marrow transplants (BMTs) from sibling donors after preparation with high doses of busulfan and cyclophosphamide. Forty-nine patients were transplanted in first complete remission (CR), and 50 patients were transplanted in second and third CR and early relapse. Fifty-three recieved one of three regimens containing primarily low-dose cyclophosphamide (group I) for graft-v-host disease (GVHD) prophylaxis; since March 1983, 46 patients received intravenous (IV) cyclosporine (group II). After December 1983, only cytomegalovirus (CMV)-seronegative blood products were used in appropriate patients, and since April 1984 patients seropositive for herpes-simplex virus (HSV) and CMV received high-dose acyclovir prophylaxis. For patients transplanted in first CR, there was a significantly lower incidence of acute GVHD (P = .005) and deaths related to GVHD and interstitial pneumonitis (P = .001) in patients in group II. This was reflected in an improved Kaplan-Meier probability of disease-free survival (DFS) in the 22 patients transplanted in group II as compared with the 27 patients in group I (64% ± 10% v 30% ± 9%, P = .017). The probability of remaining in remission was slightly lower in group II (82% ± 9% v 94% ± 6%, P = .479). For patients transplanted in second and third CR and early relapse, the incidence of acute GVHD (P = .026) and deaths related to GVHD and interstitial pneumonitis was significantly lower in group II (P = .029); the probability of remaining in remission was also less (47% ± 15% v 91% ± 15%, P = .022). However, the probability of DFS was not significantly different between the two groups (26% ± 10% v 35% ± 18%, P = .957). We conclude that transplantation for patients in first CR who received IV cyclosporine therapy is effective treatment; patients with more refractory disease treated with the same cyclosporine regimen (group II) had a lower incidence of GVHD than those treated in group I, but survival did not improve because of an increase in the number of relapses and other nonleukemic complications.

AB - Ninety-nine patients with acute nonlymphocytic leukemia (ANLL) received HLA-identical bone marrow transplants (BMTs) from sibling donors after preparation with high doses of busulfan and cyclophosphamide. Forty-nine patients were transplanted in first complete remission (CR), and 50 patients were transplanted in second and third CR and early relapse. Fifty-three recieved one of three regimens containing primarily low-dose cyclophosphamide (group I) for graft-v-host disease (GVHD) prophylaxis; since March 1983, 46 patients received intravenous (IV) cyclosporine (group II). After December 1983, only cytomegalovirus (CMV)-seronegative blood products were used in appropriate patients, and since April 1984 patients seropositive for herpes-simplex virus (HSV) and CMV received high-dose acyclovir prophylaxis. For patients transplanted in first CR, there was a significantly lower incidence of acute GVHD (P = .005) and deaths related to GVHD and interstitial pneumonitis (P = .001) in patients in group II. This was reflected in an improved Kaplan-Meier probability of disease-free survival (DFS) in the 22 patients transplanted in group II as compared with the 27 patients in group I (64% ± 10% v 30% ± 9%, P = .017). The probability of remaining in remission was slightly lower in group II (82% ± 9% v 94% ± 6%, P = .479). For patients transplanted in second and third CR and early relapse, the incidence of acute GVHD (P = .026) and deaths related to GVHD and interstitial pneumonitis was significantly lower in group II (P = .029); the probability of remaining in remission was also less (47% ± 15% v 91% ± 15%, P = .022). However, the probability of DFS was not significantly different between the two groups (26% ± 10% v 35% ± 18%, P = .957). We conclude that transplantation for patients in first CR who received IV cyclosporine therapy is effective treatment; patients with more refractory disease treated with the same cyclosporine regimen (group II) had a lower incidence of GVHD than those treated in group I, but survival did not improve because of an increase in the number of relapses and other nonleukemic complications.

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