Ann Hematol (1992) 64:128-131 AnnaLs of Original article Hematology 9 Springer-Verlag 1992 Autologous and allogeneic bone marrow transplantation in acute myeloid leukemia in first complete remission: an update of the Genoa experience with 159 patients A.M. Carella 1, E Frassoni 1, M.T. van Lint 1, E Gualandi 1, D. Occhini 1, P. Carlier 1, N. Pollicardo ~, E. Pungolino 1, F. Fagioli 2, G. Santini 3, A. Congiu 3, S. Nati 3, M.R. Raffo 1, M. Podesta ~, R. Corvo 4, V. Vitale 4, A. Gallamini 5, E.M. Pogliani 6, E. Lanzi 6, A. Bacigalupo 1, and A.M. Marmont 1 1 Bone Marrow Transplantation Unit, Division of Hematology II; z Division of Hematology I, Ospedale S. Martino, Genoa; 3 Institute of Hematology, Ferrara; 4 Service of Radiotherapy, IST, Genoa; 5 Service of Hematology, Ospedale Cuneo; 6 Division of Hematology, Ospedale S. Gerardo, Monza, Italy Received November 21, 1991/Accepted December 30, 1991 Summary. In the attempt to evaluate the role of Auto- logous and Allogeneic Bone Marrow Transplantation, we have retrospectively analyzed 159 patients with Acute Myeloid Leukemia in first complete remission treated in our Unit, most of whom were referred from other Institu- tions. High-dose therapy was uniform and consisted of cyclophosphamide 60 mg/kg/d on two consecutive days and TBI in a single dose (10 Gy) for ABMT patients and in fractionated doses (3.3 Gy • 3 days) for BMT patients. Eight years actuarial survival was similar in two groups (52~ for BMT and 49O7o for ABMT). The actuarial risk of relapse for BMT and ABMT was 29o/o and 43%, re- spectively. Considering that none of ABMT patients was "purged" with in vitro technique, this review seems to confirm the importance of "in vivo" purging with post- remission intensification, immediately before the harvest- ing. Of course, more patients and a longer follow-up are needed to drow final conclusions. Key words: AML in first CR - ABMT - BMT Introduction Allogeneic marrow transplantation (BMT) can be con- sidered for patients aged 45 or less who have on HLA- genotypicaUy or phenotypically identical family member, or a family member mismatched at a single HLA locus (A, B, or D), to serve as a marrow donor. Approximately 45%-50O1o of patients transplanted in first remission (CR-1) remain alive years later [11]. Similarly, autologous bone marrow transplantation (ABMT) with "purged" or "unpurged" marrow effectively salvages a proportion of patients with AML in second or third CR [7, 12] and yields long-term survival of 40%-61% in CR-1 [1, 3-8, Addressfor correspondence: A.M. CareUa, ABMT Section, Ospe- dale S. Martino, 16100 Genoa, Italy 10]. Critical analysis of the value of ABMT in AML in CR-1 in many studies is hampered because patients re- ceived varying inductive treatments, underwent ABMT at widely disparate times after CR, and received differing schedules of conventional therapy prior to ABMT and different high-dose chemo-radiotherapy protocols, and thus selection bias may have been substantial. The present retrospective comparative study provides data on ABMT and BMT in 159 patients with AML in CR-1 at our institution, most of whom were referred from other institutions. We synthetically describe the prelimi- nary analysis of this study, which was closed in October 1991. Patients and methods All patients with AML in CR-1 who received unmodified BMT or who received unpurged ABMT between 1983 and October 1991 are included in this report (Table 1). Induction chemotherapy consisted for most patients of the 7 + 3 protocol or the i.v. idarubicin-contain- ing protocol (3 +3 + 5 protocol) [2]. Post-remission therapy con- sisted of intermediate doses of cytarabine (ID-ARAC)500 mg/m2/d on days 1-5, followed by M-AMSA 90 mg/mZ/d on days 4-6 (EORTC-GIMEMAProtocol) or by idarubicin 12 mg/mVd on days 1-3. In ten patients this post-remission therapy consisted of four courses of the DAT protocol. The interval from diagnosis to CR, from CR to transplants, and from diagnosis to transplants is shown in Table 1. High-dose therapy was uniform and consisted of cyclophos- phamide 60 mg/kg/d on two consecutive days and total body irra- diation (TBI), in a single dose (10 Gy) for ABMT patients and in fractionated doses (3.3 Gy • 3 days) for BMT patients. Marrow was reinfused within 24 h of the last dose of TBI and the day of infusion was designated day 0. A single source of cobalt was used to give the total scheduled dose of 990 cGy. The TBI was delivered with patients in a lateral position, half the dose per side with a hori- zontal beam at a source-axis distance of 3 m. Lead shields were used to reduce overdosage to eyes, mounth, and lungs. Lungs were shielded to receive the same dose as the prescription point. The dose prescription point was the center of the pelvis, while dose readings were performed at the perineal surface between the thighs