Continuous infusion idarubicin and intravenous busulphan as conditioning regimen to autologous stem cell transplantation for patients with acute myeloid leukaemia

Abstract

The current study aimed to evaluate the efficacy and toxicity of a combination of intravenous (iv) busulfan (Bu) and continuous infusion Idarubicin (IDA) as a conditioning regimen to autologous haematopoietic stem cell transplantation (ASCT) in patients with acute myeloid leukaemia (AML). The protocol included IDA at 20 mg/sqm daily as 3 days continuous infusion (from day -13 to -11) and intravenous BU at 3.2 mg/kg daily from day -5 to -2. Patients aged over 60 years received a reduced schedule (2 days IDA and 3 days BU at the same dose). Twenty-five patients with a median age of 51 years (28-72) were enrolled. All patients received peripheral blood stem cells (PBSC). The median interval between diagnosis and ASCT was 4 months. The median number of CD34+ cells infused was 5.9 x 10E6/kg. The median number of days to PMN >500/cmm and platelets >20000/cmm was 10 and 13, respectively. In order to perform a comparison in terms of haematological and non haematological toxicity, a group of 30 patients, who were previously autografted after conditioning with IDA and oral Bu was considered. Selection of factors for a matched pair analysis included median age, percentage of subjects aged over 60 years, median CD34+ cell received, cytogenetic and molecular findings and per cent of secondary AML. As compared to previous series, the occurrence of severe mucositis was dramatically reduced (80% vs. 12%, p < 0.0001). In addition, need and duration of total parenteral nutrition (TPN), iv antibiotic therapy and hospitalization were also significantly reduced. We conclude that replacement of oral with intravenous BU results in a more favourable toxicity profile. A longer follow-up is required to assess a potential advantage in terms of disease free survival (DFS).

Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects

“…35,36 Using the same regimen, researchers in Nanjing Relevant to this study, an EBMT retrospective analysis showed that the use of G-CSF after ASCT is not associated with an increased risk of relapse. 39 The BEAM regimen has been recently advocated for T-cell ALL by the Russian ALL study group, 40 and treatment with TKI for Ph In vivo purging, MRD quantification and graft quality In the past decade numerous studies on adults and children with AML or ALL have reported that patients who achieve CR1, with no detectable MRD 41 evaluated after induction or conventional consolidation, have a significantly better outcome compared with MRD-positive patients.…”

Continuous sequential infusion of fludarabine and cytarabine for elderly patients with acute myeloid leukaemia secondary to a previously diagnosed myelodysplastic syndrome

“…Following consolidation, G-CSF at 10 mg/kg was given from day 15 with the aim of shortening neutropenia and mobilizing CD34þ cells. In all patients with successful collection of CD34þ cells (!2 Â 10 6 /kg) ASCT was programmed with conditioning regimen consisting of high dose CI idarubicin plus busulphan, as previously described [20,21]. A PS < 3, absence of active infection and/or severe organ damage were required to be considered for ASCT.…”

Idarubicin-intensified BUCY2 regimens may lower relapse rate and improve survival in patients undergoing allo-SCT for high-risk hematological malignancies: a retrospective analysis

“…BU and continuous infusion IDA as a conditioning regimen for auto-SCT in patients with AML and a better outcome was found. [16][17][18][19] Therefore, we investigated combinations of BU with IDA instead of BUCY2 as a myeloablative conditioning regimen that may result in effective and well-tolerated myeloablative conditioning regimens. Here, we report the results obtained in our institute retrospectively by comparing standard vs IDA-intensified BUCY2 (IDA-BUCY2) myeloablative conditioning regimens in allo-PBSCT for high-risk hematological malignancies over a period of several years.…”