Long-term outcome of autologous transplantation of peripheral blood progenitor cells as postremission management of adult acute myelogenous leukemia in first complete remission

Abstract

In order to improve leukemia-free survival (LFS) without the treatment-related morbidity of allogeneic bone marrow transplantation or multiple prolonged cycles of consolidation chemotherapy, we evaluated the long-term outcome of autologous transplantation of peripheral blood progenitor cells (PBPCs) as postremission therapy in 129 patients aged 18-71 years (median 49 years) with newly diagnosed acute myelogenous leukemia (AML) in first complete remission (CR1). The median follow-up from remission for surviving patients was 62.2 months (range 3.7-127.9 months). A total of 57 patients were alive and leukemia free at the end of the study. The LFS and overall survival 5 years from remission were 40.2% (79.2%) and 41.4% (79.4%), respectively. The median LFS and overall survival are 17.3 and 23.3 months, respectively. Multivariate analysis identified age as the most significant predictor for both LFS and overall survival. Karyotype was also found to be predictive of outcome. Our results show that autologous transplantation of PBPC procured after a single cycle of highdose cytarabine-based consolidation chemotherapy for a population of adult patients with AML in CR1 produces a high likelihood of long-term LFS, offering a state of clinical minimal residual disease for the investigation of future therapeutic approaches.

BU/melphalan and auto-SCT in AML patients in first CR: a ‘Gruppo Italiano Trapianto di Midollo Osseo (GITMO)’ retrospective study

“…When we analyzed the short-term outcome, we found that, similar to earlier studies, [7][8][9] PBSC transplantation resulted in a significant shorter time to hematological reconstitution as compared with BM grafts. 29,30 However, the stem cell source did not significantly affect the clinical outcome of AML patients, as we have already showed in our previous long-term single-center analysis.…”

“…Thus, several retrospective studies have shown improved longterm results when autologous PBSCs were reinfused as compared with BM cells. [7][8][9] Few phase III studies have also addressed the role of allo-SCT and auto-SCT in young AML patients in first CR with respect to cytogenetic categories. [10][11][12] Suciu et al 10 showed similar DFS rate for good/intermediate-risk patients receiving either allo-SCT or auto-SCT, whereas auto-SCT resulted in a lower DFS rate in AML patients with unfavorable cytogenetics because of the higher relapse rate.…”

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

“…1,[11][12][13][14] However, the optimal postremission treatment and preparative regimen are still in dispute. More intense conditioning may lead to higher transplant-related mortality (TRM).…”

Chemotherapy for patients with acute myeloid leukemia in first remission

“…A confounding factor in all studies was the higher risk of treatment-related mortality with autologous BMT, a problem potentially now largely resolved with the use of autologous peripheral blood stem cells [21]. A second issue is the use of ex-vivo bone marrow purging technologies to remove residual clonogenic leukemic cells from stem cell harvests.…”