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1102 Cardiorespiratory Medicine and Haematology, Immunology

Abstract:

Treatment of patients with MDS or s AML remains unsatisfactory. Therefore, we initiated a study to assess the efficacy of intensive remission-induction chemotherapy and therapeutic potential of ABMT, autologous PBSCT and alloBMT in a prospective, controlled study. The induction regimen consists of Idarubicin: 10 mg/mVday on days 1,3,5, Ara-C: 100 mg/mVday days 1-10, and Etoposide: 100 mg/mVday, on days 1-5. Patients in CR receive one consolidation course consisting of: Ara-C: 2x500 mg/mVday, on days 1-6 and Novantrone: 12 mg/mVday, on days 4-6. From the 20th day of the consolidation course 300 ug of Filgrastim (s.c.) is given daily to mobilize PBSC. All patients <55 years with an HLA-identical sibling are proposed for alloBMT. The remaining patients in CR should receive ASCT. 147 patients have been registered since November 1992. Data are available from 96 patients. 59 patients (61%) entered CR after 1 or 2 remission-induction courses. 17 patients (18%) died during hypoplasia. 5 patients entered CR after salvage alloBMT (4) or chemotherapy ( 1 ). L 7 of the 22 patients with an identical sibling were transplanted in first CR. Eleven patients were alive and disease-free. 21 of the 28 patients without a donor received either ABMT (13) or PBSCT (8). The median recovery to a leukocyte count of >0.5 x 109/1 was significantly faster after PBSCT compared to ABMT (on day 11 and 35 respectively). 16 of the autografted patients were alive and well, 1 patient died due to complications and 4 patients have relapsed. The survival at 2 years was 34% and the disease-free survival of the complete remitters was 36. 38 of 59 complete remitters (64%) have received the full protocol including SCT. This analysis shows that ASCT is feasible in patients with MDS. With this approach the prognosis of these patients might be improved.