Unrelated donor marrow transplantation for acute myeloid leukemia: an update of the Seattle experience

Between 1985 and 1998, 161 patients with primary acute myeloid leukemia (AML) received T-replete hone marrow transplantation (BMT) from unrelated donors in Seattle. Median age was 30 (range 1-55) years. Conditioning for Bh IT consisted of cyclophosphamide and total body irradiation in 154 (96%) cases and graft-versus-host disease prophylaxis was the standard methotrexate and cyclosporine combination in 134 (83%) cases. Median post-transplant follow-up was 2.9 years, Leukemia-free survival (LFS) at 5 years was 50 +/- 12% for transplants during first complete remission (n = 16), 28 +/- 8% during second CR (n = 40), 27 +/- 17% during subsequent CR (n = 8), 7 +/- 3% during relapse (n = 81) and 19 +/- 10% during primary induction failure (n = 16), The cumulative incidences of relapse were 19%, 23%, 25%, 44% and 63%, for the five groups, respectively. Transplantation during remission, a marrow cell dose above 3.5 x 10(8)/kg, and cytomegalovirus seronegative status before BMT in both patient and donor were favorable prognostic factors, Adults in any CR who received a marrow cell dose above 3.5 x 10(8)/mg had a LFS of 54 +/- 9% at 5 years. These data extend our previous findings on the association between a high marrow cell dose and improved survival and support the use of unrelated donor BMT for treatment of patients with high risk AML when a family match is not available.