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Relevance of Bone Marrow Cell Dose on Allogeneic Transplantation Outcomes for Patients With Acute Myeloid Leukemia in First Complete Remission: Results of a European Survey

From the Hematopoietic Stem Cell Transplant Unit, Hôpital Saint Louis, and Service d’Hématologie, CHU Saint-Antoine and European Data Management Office (Centre International Greffes de Moelle AP-HP et Centre de Recherche Claude Bernard sur la Thérapie Cellulaire), Institut des Cordeliers, Paris; and Hôpital du Haut Leveque, Pessac, France; Helsinki University Central Hospital, Helsinki, Finland; University "La Sapienza," Rome, and Ospedale San Martino, Genoa, Italy; Hospital Universitario Marqués de Valdecilla, Santander, Spain; and Huddinge University Hospital, Huddinge, Sweden.

Address reprint requests to Vanderson Rocha, MD, Hôpital Saint Louis–Unité de Recherche Clinique, 1, av Claude Vellefaux, 75010 Paris, France; email: vanderson.rocha{at}sls.ap-hop-paris.fr

PURPOSE: Many attempts have been made to improve the results of allogeneic bone marrow transplantation (alloBMT) for patients with acute myeloid leukemia (AML) in first complete remission (CR1). Bone marrow cell dose has been reported to be an important factor in alloBMT; however, its true impact on relapse incidence (RI), leukemia-free survival (LFS), and nonrelapse mortality (NRM) in a large cohort of patients is unknown.

PATIENTS AND METHODS: From January 1992 to December 1999, 572 bone marrow transplantation recipients reported to the European Blood and Marrow Transplantation (EBMT) registry underwent allografting from an HLA-identical sibling donor with an unmanipulated bone marrow for AML in CR1.

RESULTS: The median number of nucleated cells (NCs) infused was 2.6 x 10⁸/kg. Estimated 5-year NRM, LFS, and RI for patients receiving more or less than 2.6 x 10⁸ NCs/kg were, respectively, 18% ± 5% v 30% ± 5% (P = .001), 68% ± 3% v 46% ± 3% (P < .00001), and 14% ± 4% v 24% ± 5% (P = .004). The association of cell dose with the above outcomes was confirmed in multivariate analyses for NRM (relative risk [RR], 0.53; P = .0007), for LFS (RR, 0.53; P = .00008), and for RI (RR, 0.57; P = .02). The cell dose was also an important factor for neutrophil (RR, 0.76; P = .009) and platelet (RR, 0.77; P = .03) recoveries; however, it did not statistically influence the incidence of acute graft-versus-host disease.

CONCLUSION: This study shows that marrow cell dose is one of the most important factors influencing relapse, NRM, and LFS after alloBMT for patients with AML in CR1. Therefore, increasing the marrow cell dose should substantially improve the survival of these patients.

Presented in part at the Forty-Second Annual Meeting of the American Society of Hematology, San Francisco, CA, December 1-5, 2000.

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