New York, N.Y., January 21, 1998 - Physicians at Memorial Sloan-Kettering Cancer Center have developed an innovative treatment for patients with acute myelogenous leukemia (AML) that results in long-term survival without cancer recurrence. In a study published in the February 1st issue of Blood, Memorial Sloan-Kettering researchers reported that 77% of adult AML patients who received a transplant of T-cell depleted bone marrow from a donor were cancer free as long as 6 years later. Less than 4% of patients suffered a relapse. This is especially significant because the majority of patients with AML are at high risk for cancer recurrence even if chemotherapy can successfully produce remission.
"Our study has shown long-term, disease-free survival for a high proportion of adult patients who received this new treatment," said Dr. Esperanza Papadopoulos, a specialist in bone marrow transplantation at Memorial Sloan-Kettering and the paper's lead author. "All surviving patients have continued to do well."
Although it is known that T-cells can cause graft-versus-host disease, a life-threatening condition in which the marrow graft reacts against the patient, current thinking has been that some form of graft-versus-host disease was in fact, necessary for a patient to maintain remission after transplantation. Because the researchers at Memorial Sloan- Kettering thought that it would be preferable to prevent the complications of graft-versus- host disease, they removed the majority of the T-cells from the donor's bone marrow prior to the transplant. In the study, patients received aggressive treatment consisting of total body irradiation and chemotherapy. They then received an allogeneic, T-cell depleted bone marrow graft from a sibling with identical tissue typing. In addition, an immunosuppressant was administered to help prevent rejection.
"We have found that using T-cell depleted bone marrow, 31 adults transplanted for AML after first remission had a survival rate of 77.4% while 8 patients who had already experienced one recurrence had a survival rate of 50% after second remission," said Dr. James Young, a bone marrow transplant expert at Memorial Sloan-Kettering and the paper's senior author. "This method limits the risk of developing graft-versus-host disease and is associated with an extremely low rate of leukemic recurrence."
Dr. Richard O'Reilly, Chief of the Bone Marrow Transplant Service at Memorial Sloan- Kettering explained that their study also included older patients who are sometimes considered inappropriate candidates for bone marrow transplantation. "Using this regimen, we offered treatment to patients over the age of 40 who were at higher risk of graft-versus-host disease and its complications," he said. These ten patients had a disease- free survival rate of 70%. "With this procedure's lower percentage of relapse, higher survival rates, and much lower risk of graft-versus-host disease, we feel this procedure will help a significant number of adult patients with AML remain cancer free," said Dr. O'Reilly.
Memorial Sloan-Kettering Cancer Center is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer. Throughout its long distinguished history, the Center has played a leadership role in defining the standard of care for patients with cancer. In 1997, Memorial Sloan-Kettering was named the nation's best cancer care center for the fifth consecutive year by U.S. News & World Report.
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Journal
Blood