Autologous stem cell transplantation using modified TAM or combination of triple-alkylating agents conditioning regimens as one of the post-remission treatments in patients with adult acute myeloid leukemia in first complete remission

Abstract

Summary:A total of 174 newly diagnosed adult acute myeloid leukaemia (AML) patients were treated in first complete remission (CR1) using modified TAM or a combination of triple-alkylating agents followed by autologous transplantation (AT). Cytogenetic risk groups were classified and most patients received mobilized peripheral blood stem/ progenitor cells (PBSCs). The infused cell dose consisted of a median of 4.172 (range, 1.2-17.1) Â 10 6 /kg CD34 þ cells. With a median follow-up of 51 months (range, 5-131 months) after CR1, the estimated 5-year disease-free survival (DFS) rate was 68 (95% confidence interval (CI), 63-73%) and the event-free survival rate at 5 years was 59 (95% CI, 54-64%). AML patients other than M3 subtype, the long-term DFS rate was 76, 33% for favourable and unfavourable risk groups, respectively. In all, 40 patients had relapses (40/174, 23%) at the median 15 months after CR1 (range, 8-66 months). Overall, seven patients (4%) died in connection with AT. The infused CD34 þ cell dose (P ¼ 0.0389) was associated with survival by multivariate analysis. In conclusion, two novel conditioning regimens in AT are feasible for adults with variable risk AML followed for over a 10-year period.

Overcoming various comorbidities by G-CSF-primed unmanipulated BM SCT in adult patients with AML

“…However, a higher incidence of chronic GVHD in PBSCT compared to SCT using sBM may be more acceptable with current management strategies. 1,2,8,9,15 Moreover, based on a meta-analysis performed in 2001, PBSCT involves a slightly increased risk of acute GVHD. 16 More importantly, recent studies have found no significant difference between PBSCT and SCT using pBM in terms of engraftment, although PBSCT involved a significantly increased risk of acute and/or chronic GVHD.…”

“…Chemotherapy before SCT Since its introduction in 1996, our center's chemotherapy regimen for AML has undergone several modifications that have been documented in previous publications, [12][13][14][15] and all patients enrolled in this study were treated according to the last updated standard protocol. All patients with AML were subjected to the same induction and consolidation strategy.…”

Equivalent Outcome of Autologous Stem Cell Transplantation and Reduced Intensity Conditioning Stem Cell Transplantation in Acute Myeloid Leukemia Patients with t(8;21)

“…Patients assigned to the ASCT group were prepared by means of our modified transplant-associated microangiopathy regimen [11], which consisted of fractionated total body irradiation (10 Gy, 5 fractions in 3 days) from day -8 to -6, followed by intermediate-dose Ara-C (6 doses of 1.5 g/m 2 over 3 h every 12 h) from day -5 to -3 and melphalan (100 mg/m 2 over 30 min) on day -2 only.…”

Identification of molecular and cytogenetic risk factors for unfavorable core-binding factor-positive adult AML with post-remission treatment outcome analysis including transplantation

“…If the patient did not have an available donor, we provided auto-HSCT with a myeloablative conditioning regimen consisting of ARA-C (9 g/m 2 ), melphalan (100 mg/ m 2 ) and 1200 cGy of TBI after two cycles of consolidation. 24 The rest of the patients finished treatments with three cycles of consolidation chemotherapies.…”