Autologous stem cell transplantation for acute myeloid leukemia in first remission

Abstract

We studied the feasibility, toxicity, and efficacy of a 2-step approach to autologous stem cell transplantation for patients with acute myeloid leukemia in first remission. Step 1 consisted of consolidation chemotherapy including cytarabine 2000 mg/m2 twice daily for 4 days concurrent with etoposide 40 mg/kg by continuous infusion over 4 days. During the recovery from this chemotherapy, peripheral blood stem cells were collected under granulocyte colony-stimulating factor stimulation. Step 2, autologous stem cell transplantation, involved the preparative regimen of busulfan 16 mg/kg followed by etoposide 60 mg/kg and reinfusion of unpurged peripheral blood stem cells. A total of 128 patients were treated. During step 1, there was 1 treatment-related death. A median CD34+ cell dose of 14 (x10(6)/kg) was collected in 3 aphereses. Ten patients suffered relapse before transplantation, and 117 patients (91%) proceeded to transplantation. During step 2, there were 2 treatment-related deaths, and 35 patients subsequently suffered relapse. With median follow-up of 30 months, 5-year disease-free survival for all patients entered in the study is projected to be 55%. By cytogenetic risk group, 5-year disease-free survival is 73% for favorable-risk patients, 51% for intermediate-risk patients, and 0% for poor-risk patients. We conclude that this 2-step approach to autologous transplantation produces excellent stem cell yields and allows a high percentage of patients to receive the intended therapy. Preliminary efficacy analysis is very encouraging, with outcomes that appear superior to those of conventional chemotherapy.

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

“…However, the results in patients with high cytogenetic risk disease were dismal and not superior to published results of CHT alone after attaining CR. [1,2,8,[14][15][16]. Therefore, patients with poor cytogenetic prognosis AML lacking an HLA-matched donor should probably be offered an allogeneic SCT from an alternative unrelated donor or from a haplotype-mismatched related donor.…”

Autologous hematopoietic cell transplantation for high-risk ALL

“…We used an intensive consolidation treatment with high-dose cytarabine and etoposide that has been used in AHCT for AML and has produced excellent hematopoietic cell mobilization. 6 The aims of this consolidation therapy were to decrease leukemia cell burden in the patient, produce good progenitor cell mobilization and provide in vivo purging of the graft. We performed ex vivo purging of the graft with a combination of monoclonal antibodies and complement in order to further reduce leukemic contamination.…”

More efficient mobilisation of peripheral blood stem cells with HiDAC+AMSA+G-CSF than with mini-ICE+G-CSF in patients with AML

“…As for mini-ICE, consolidation with intermediate/ high-dose cytarabine7etoposide has been associated with adequate collection of PBSC in patients with AML. 13,14,20,26 Thus, it is tempting to speculate that the idarubicine component may have had a negative impact on mobilisation. Indeed, certain chemotherapeutic drugs, such as fludarabine, have been reported to impair mobilisation of PBSC.…”

“…Peak B-CD34 ((19 (2-262)m/l)) was observed on day 23 (17-31) ( Table 2). Notably, 18/20 patients reached B-CD34 45/ml and therefore underwent 1 (1-4) leukaphereses, starting on day 23 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). All except one of these patients reached the target harvest yield after 1-3 leukaphereses (Table 3).…”