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Bone marrow transplantation for acute myeloblastic leukaemia: an EBMT Leukaemia Working Party prospective analysis from HLA‐typing
Author(s) -
Ljungman Per,
Witte Theo,
Verdonck Leo,
Gahrton Gösta,
Freycon Fernand,
Gravett Peter,
McCann Shaun,
Morgenstern H. G.,
Nikoskelainen Jukka,
Powles Ray,
Proctor Steven J.,
Volin Liisa,
Zwaan Ferry,
Gratwohl Alois
Publication year - 1993
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1993.tb03025.x
Subject(s) - medicine , bone marrow , transplantation , acute myeloblastic leukemia , human leukocyte antigen , surgery , chemotherapy , leukemia , immunology , antigen
Summary. The optimal post‐remission therapy for patients with acute myeloblastic leukaemia remains controversial. Allogeneic bone marrow transplantation, autologous bone marrow transplantation, and consolidation chemotherapy are the major options. In order to evaluate their respective value the European Group for Bone Marrow Transplantation conducted a prospective registration study. Patients with newly diagnosed acute myeloblastic leukaemia were registered at the time of HLA‐typing and intention to treat in case of presence or absence of an HLA‐identical donor was recorded. 27/79 (34%) patients HLA‐typed at diagnosis had an identical donor identified. The estimated survivals at 3 years from HLA‐typing were 44% and 21% among patients with or without HLA‐identical donor, respectively ( P = 0·02). 22/26 (85%) patients for whom allogeneic bone marrow transplantation was intended were transplanted but only 15/47 (32%) patients for whom autologous bone marrow transplantation was intended were indeed transplanted ( P < 0·001). The survival was 50%. 29% and 17% ( P = 0·004) for patients treated with allogeneic bone marrow transplantation, autologous bone marrow transplantation, or chemotherapy, respectively. 40/68 patients HLA‐typed in first complete remission had an HLA‐identical donor. The estimated 3‐year survival among patients typed in first remission with and without HLA‐identical donors was 42% and 35% (n.s.), respectively. This technique of early patient registration illustrates the problems of patient selection during the course of the disease and might be used as a complement to randomized trials when comparing bone marrow transplantation and other treatment options.