TY - JOUR
T1 - Autologous bone marrow transplantation (ABMT) is not superior to intensive consolidation chemotherapy (ICC) for post-remission therapy in adult acute myeloblast1c leukemia (AML)
T2 - Final analysis of the goelam's study
AU - Cahn, J. Y.
AU - Harousseau, J. L.
AU - Pignon, B.
AU - Witz, F.
AU - Delain, M.
AU - Lioure, B.
AU - Lamy, T.
AU - Solary, E.
AU - Desablens, B.
AU - Brière, J.
AU - Casasus, P.
AU - Audhuy, B.
AU - Polin, V.
AU - Hurteloup, T.
AU - Tellier, Z.
PY - 1996/12/1
Y1 - 1996/12/1
N2 - From Nov 1987 to May 1994, 535 patients (pu) with de novo AML and from 15 lo 50 yean of age (median 36) were included in the GOELAM t protocol. The induction treatment was a combination of ARA-C (200 mg/ro2/D Dl-7 continuous infusion) with either Idarubicin (IDR) (8 mg/m2/D iv Dl-5) or Rubidawne (RBZ) (200 mgM2/D iv Dl-4) Out of 503 évaluable patients, 366 (73%) achieved a complete remission (CR) without significant difference between the iwo anihracyclines. Pts with an HLAidenucdl sibling were eligible for ailogeruc Bone Marrow Transplantation (BMT) up to the ige of 40. All other pauenis received a first cycle of ICC (ICC1) with high dose ARA-C (3g/m2 over 3Hrs q.12Hrs D14) and either IDR (10 mg/m2/D iv D5-6) or RBZ (200 mg/m2/D iv D5-6). They were then randomized between a second cycle of ICC (ICC2) with m-AMSA (150 mg/m2/D iv Dl-5) and VP16 (100 mg/m2tf) iv D1-5) or Busulfan (4 mgAg/D po Dl-4) plus Cyclophosphamide (200 m|Ag/D iv D5-S) followed by ABMT. Marrow was collected after 1CC1 and not purged. Only 218 of the 366 CR pis (59%) did actually receive the scheduled intensive post remission regimen (72 allo BMT, 75 ABMT, 71 ICC2). The reasons for non completing the whole protocol were hématologie toxicity 40, extrahemalologic (oxicily 27, protocol violation 26, refusal 24, relapse 22, toxic death 7, others 1. With a median follow-up of 4 years, ihe 4 year disease free survival (DPS) of the 366 CR pts was 39%. The overall 4-yei survival (SV) of the 517 eligible pts was 39%. Thiee parameters hid significant impact on the outcome: initial white blood cell count (±30.109/L). FAB classification (M2-M3 versus others) and karyotype. When considering the imention to ffeat. the 4-year DPS and SV were 42% and 51% for allo BMT. 40% and 52,5% for pis assigned to ICC1 (p=NS). 16d pis were randomised between ABMT (N=86) and ICC2 (N=78). The two year DPS and SV were 42% and 48% for ABMT, 38% and 56,5% for ICC2 (p=NS). In conclusion, after a first cycle of ICC, ABMT and a second cycle of ICC result in comparable DPS and SV; allo BMT is not superior lo other types of intensive post remission therapy in this study.
AB - From Nov 1987 to May 1994, 535 patients (pu) with de novo AML and from 15 lo 50 yean of age (median 36) were included in the GOELAM t protocol. The induction treatment was a combination of ARA-C (200 mg/ro2/D Dl-7 continuous infusion) with either Idarubicin (IDR) (8 mg/m2/D iv Dl-5) or Rubidawne (RBZ) (200 mgM2/D iv Dl-4) Out of 503 évaluable patients, 366 (73%) achieved a complete remission (CR) without significant difference between the iwo anihracyclines. Pts with an HLAidenucdl sibling were eligible for ailogeruc Bone Marrow Transplantation (BMT) up to the ige of 40. All other pauenis received a first cycle of ICC (ICC1) with high dose ARA-C (3g/m2 over 3Hrs q.12Hrs D14) and either IDR (10 mg/m2/D iv D5-6) or RBZ (200 mg/m2/D iv D5-6). They were then randomized between a second cycle of ICC (ICC2) with m-AMSA (150 mg/m2/D iv Dl-5) and VP16 (100 mg/m2tf) iv D1-5) or Busulfan (4 mgAg/D po Dl-4) plus Cyclophosphamide (200 m|Ag/D iv D5-S) followed by ABMT. Marrow was collected after 1CC1 and not purged. Only 218 of the 366 CR pis (59%) did actually receive the scheduled intensive post remission regimen (72 allo BMT, 75 ABMT, 71 ICC2). The reasons for non completing the whole protocol were hématologie toxicity 40, extrahemalologic (oxicily 27, protocol violation 26, refusal 24, relapse 22, toxic death 7, others 1. With a median follow-up of 4 years, ihe 4 year disease free survival (DPS) of the 366 CR pts was 39%. The overall 4-yei survival (SV) of the 517 eligible pts was 39%. Thiee parameters hid significant impact on the outcome: initial white blood cell count (±30.109/L). FAB classification (M2-M3 versus others) and karyotype. When considering the imention to ffeat. the 4-year DPS and SV were 42% and 51% for allo BMT. 40% and 52,5% for pis assigned to ICC1 (p=NS). 16d pis were randomised between ABMT (N=86) and ICC2 (N=78). The two year DPS and SV were 42% and 48% for ABMT, 38% and 56,5% for ICC2 (p=NS). In conclusion, after a first cycle of ICC, ABMT and a second cycle of ICC result in comparable DPS and SV; allo BMT is not superior lo other types of intensive post remission therapy in this study.
UR - http://www.scopus.com/inward/record.url?scp=33748626253&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:33748626253
SN - 0301-472X
VL - 24
SP - 1147
JO - Experimental Hematology
JF - Experimental Hematology
IS - 9
ER -