Autologous peripheral blood stem cell transplantation for acute myelogenous leukemia

Abstract

Summary:with acute myelogenous leukemia (AML). 1,2 However, most will relapse despite consolidation and maintenance chemotherapy. Therefore, post-remission therapy is one of The safety and efficacy of myeloablative therapy followed by autologous peripheral blood stem cell transthe most important issues in the treatment of AML. An increasing number of AML patients have been treated with plantation (ABSCT) for acute myelogenous leukemia (AML) were evaluated in 60 patients. Peripheral blood intensified consolidation chemotherapy, autologous bone marrow transplantation (BMT), or allogeneic BMT. ditioning regimen and graft-versus-leukemia (GVL) effects. 5 Nevertheless, in addition to the requirement of was used for pretransplant conditioning in 13 patients. For the remaining 47 patients, granulocyte colony-HLA-identical marrow donors, transplant-related morbidity and mortality remain the major obstacles to improving stimulating factor (G-CSF) was administered concurrently with the BEA regimen during conditioning.clinical results of allogeneic BMT. In autologous BMT, regimen-related toxicities are fewer, although a GVL effect Unpurged, cryopreserved PBSC containing a median number of 5.4 × 10 8 MNC/kg or 12 × 10 4 CFU-GM/kg cannot be obtained. One randomized study has demonstrated that patients treated with autologous BMT have were reinfused at transplantation. The median number of days to granulocytes exceeding 500/l and last platesuperior disease-free survivals (DFS) to those receiving intensive chemotherapy alone.3 let transfusion were 15 (8-44) and 24 (0-Ͼ180), respectively. The 3-year probabilities of disease-free survival Recently, autologous peripheral blood stem cell transplantation (ABSCT) has begun to replace autologous BMT (DFS) and relapse were 78.6 and 21.4% for patients transplanted in first remission, 29.6 and 64.4% for those because of rapid engraftment and low transplant-related mortality. 6-11 However, high relapse rates have been in second or third remission, and 11.1 and 77.8% for those in relapse, respectively. There were no transplantreported after ABSCT for AML. from all patients or responsible family members.

Is there still a role for autologous stem cell transplantation in acute myeloid leukemia?

“…It is now well proven that hemopoiesis recovery (engraftment) is more rapid with PBSCT than with BMSCT [11][12][13]. The most important factor for hemopoietic recovery after ASCT is the dose of progenitor cells infused [11][12][13]. In our study the engraftment after PBSCT was significantly shorter than after BMSCT by 11 days (for neutrophils recovery) and by 37 days (for platelets recovery), and it was comparable with other series.…”

“…It is now well proven that hemopoiesis recovery (engraftment) is more rapid with PBSCT than with BMSCT [11][12][13]. The most important factor for hemopoietic recovery after ASCT is the dose of progenitor cells infused [11][12][13].…”

Conditioning with targeted busulfan for autologous peripheral blood stem cells transplantation for acute myelogenous leukemia in an XYY male

“…Sanz et al reported fatal VOD in 2 of 24 patients who received a fixed dose of BU (16 mg/kg) and cyclophosphamide (CY, 200 mg/kg) followed by auto-PBSCT for AML [19]. As reported previously, we found no TRM among 60 AML patients treated with a fixed dose of the G-CSF-combined-BEA regimen, and only 2 patients developed hepatic toxicity greater than grade 2; however, early severe hepatic toxicity developed in 1 patient who was autografted in second remission [16]. Thus, in patients who have a high risk of TRM, e.g., patients with advanced stages or those receiving multiple courses of transplantation, adjustment of the targeting dose of BU may be helpful to avoid severe RRT even in the setting of autologous transplantation.…”

“…The patient was treated with a pre-transplant conditioning regimen consisting of BU 0.8 mg/kg orally every 6 hr on days À8 to À5, etoposide 20 mg/kg iv on days À4 and À3, CA 100 mg/m 2 continuous iv on days À12 to À5, CA 3 g/m 2 iv every 12 hr on days À4 and À3, and G-CSF at a dose of 5 mg/kg on days À14 to À8 and 10 mg/kg on days À7 to À4 as described previously [16]. To provide the accurate assessment of BU plasma levels during conditioning, blood samples were collected at 2 and 6 hr on days À7 and À6 of BU administration.…”

Successful Treatment of Bulky Granulocytic Sarcoma of the Retroperitoneum with High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation

“…The safety and efficacy of this regimen for the treatment of AML were evaluated previously, 5,6 and the administration of G-CSF enhanced the efficacy of chemotherapy in patients with AML. 7 After the conditioning chemotherapy, peripheral blood stem cells were reinfused.…”