Correspondence

Follow-up 26 Years after Treatment for Acute Myelogenous Leukemia

N Engl J Med 2004; 351:2456-2457December 2, 2004

Article

To the Editor:

In 1979, we reported the results of treating 19 patients who had acute myelogenous leukemia in first remission with intensive chemotherapy, radiation therapy, and transplantation of allogeneic marrow from HLA-identical siblings between March 1976 and March 1978.1 These patients had been treated with cyclophosphamide, total-body irradiation (one exposure of 920 cGy), and prophylaxis with methotrexate for graft-versus-host disease (GVHD). Five patients died from interstitial pneumonia within six months of transplantation, one patient relapsed and died at one year, and one died at one year with septicemia complicating chronic GVHD. Four patients were alive with minimal chronic GVHD, and eight were alive and well without GVHD. The events for the subsequent 25-year period for these survivors are reported here (Figure 1Figure 1Updated Kaplan–Meier Estimates of Survival and the Cumulative Incidence of Relapse among the 19 Patients.).

One patient died with pulmonary fibrosis 4.6 years after transplantation. Subsequent relapses occurred in two patients. One relapsed at 2.3 years (and died at 2.5 years); another relapsed at 6.3 years after transplantation, received a second transplant, and relapsed 3.9 years after the second transplantation. This patient died 4.4 years after the second transplantation and 10.8 years after the first.

Four patients had minimal GVHD at the time of the original report. The condition persisted in one patient, in whom generalized scleroderma developed, followed by acute respiratory distress syndrome at 13.6 years, which proved fatal. Another patient had persistent GVHD with mild skin involvement, had a bladder carcinoma, and then died at 22 years. In the other two patients, GVHD activity ceased within two years after the transplantation. No new cases of GVHD were recorded after the original report.

The seven survivors, who were 9 to 25 years of age (median, 17) when they received their transplants, were contacted within the past year and are alive and in continuing remission, between 26.0 and 27.3 years after transplantation. Throughout the past 10 years, six survivors have had peripheral-blood counts within normal limits on their annual examinations; one (reporting excellent health) has refused testing. None have had bone marrow examinations. Four survivors have controlled type 2 diabetes; one is in remission at two years after mastectomy for breast cancer, but she has recently been given a diagnosis of pulmonary fibrosis. One has minor manifestations of sicca syndrome.

R.A. Clift, F.I.M.L.S.
E.D. Thomas, M.D.
Fred Hutchinson Cancer Research Center, Seattle, WA 98109

for the Seattle Marrow Transplant Team

1 References

1. 1

   Thomas ED, Buckner CD, Clift RA, et al. Marrow transplantation for acute nonlymphoblastic leukemia in first remission. N Engl J Med 1979;301:597-599
   Full Text | Web of Science | Medline

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   Stella M. Davies, Jacob M. Rowe, Frederick R. Appelbaum. (2008) Indications for Hematopoietic Cell Transplantation in Acute Leukemia. Biology of Blood and Marrow Transplantation 14:1, 154-164
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