Use of peripheral blood stem cells for autologous transplantation in acute myeloid leukemia patients allows faster engraftment and equivalent disease-free survival compared with bone marrow cells

Abstract

Summary:We compared the feasibility and efficacy of autologous bone marrow (ABMT) and peripheral blood progenitor cell transplantation (PBSCT) performed after an identical induction/consolidation in adults with acute myeloid leukemia (AML). From January 1993 to June 1996 91 consecutive AML patients were enrolled in a program consisting of anthracycline-based induction and highdose cytarabine consolidation (NOVIA). Until May 1994 ABMT was performed; from June 1994, if PBSC collection was adequate, PBSCT was performed. Out of 88 evaluable patients, 73 obtained a complete remission (CR) and 15 were resistant. Allogeneic bone marrow transplantation was performed in 16 patients. Fortyfour (50%) were given autologous stem cell transplantation. ABMT was performed in 21 cases; twenty-nine patients were given G-CSF mobilization after NOVIA administration. An adequate number of PBSC was obtained in 23/29 (79%) cases, which were then reinfused. Median times to both neutrophil and platelet recovery from transplant were significantly shorter for the PBSC group (17 vs 36 days to 500 PMN/l, P Ͻ Ͻ Ͻ 0.01; 20 vs 150 days to 20 000 platelets/l, P Ͻ Ͻ Ͻ 0.02; 37 vs 279 days to 50 000 platelets/l, P Ͻ Ͻ Ͻ 0.03), as were days of hospitalization after the reinfusion (18 vs 33, P Ͻ Ͻ Ͻ 0.03) and median days to transfusion independence. Toxicity was not significant in either group. After a minimum follow-up for live patients of 24 months (longer than the mean time for relapse observed for the PBSC series -14 months) the percentage of relapses was similar: 11 of 21 (52.4%) and 12 of 23 (52.1%) in the ABMT and PBSC groups, respectively. Our results indicate that autologous PBSC transplantation, performed after an intensive chemotherapy regimen, is not inferior to ABMT in terms of disease-free survival and allows faster recovery times and reduced need for tranfusion support.

Double reinforcement with fludarabine/high-dose cytarabine enhances the impact of autologous stem cell transplantation in acute myeloid leukemia patients

“…Stem cells harvest, cryopreservation and thawing procedures have already been reported. 6,20 Progenitor cell apheresis was begun after an absolute count of 10 CD34 + cells/ l was achieved during the recovery phase after consolidation therapy. As already reported, 17,18,21 circulating stem cells were collected by using either a Fenwal CS3000 continuous flow blood cell separator (Baxter, Rome, Italy) or a Cobe Spectra separator (Cobe BCT, Lakewood, CO, USA) to obtain a minimum yield of 2 × 10 6 CD34 + cells/kg.…”

“…This group of patients has already been reported. 6 The consolidation regimen was as follows: cytarabine 500 mg/m 2 /twice a day on days 1-6; mitoxantrone 12 mg/m 2 /day on days 4-6. From January 1993 to May 1994, patients in CR then underwent a bone marrow harvest.…”

“…Non-mobilizing patients underwent bone marrow harvest, as previously reported. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The final apheresis product was concentrated and cryopreserved as described. When applicable, cytogenetic and molecular analyses were performed in order to confirm CR.…”

“…4,5 The relative advantages and disadvantages of autologous bone marrow transplantation (ABMT) and peripheral blood stem cell transplantation (PBSCT) are still under evaluation. 6 Despite encouraging results from randomized trials showing a clinical benefit for AML patients undergoing ASCT in first complete remission (CR), relapse remains the most frequent cause of treatment failure. 7,8 Thus, intensification of induction/ consolidation chemotherapy, mainly based on high-dose cytarabine, has been suggested to improve in vivo purging prior to auto-SCT.…”

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

“…A significant number of patients with myeloid malignancies mobilise poorly in response to chemotherapy (CT) and G-CSF 8,9 Apart from the dose and scheduling of G-CSF, 7 the intensity and type of CT regimen used may be important for the successful collection of PBSC. [10][11][12] Thus, priming with high-dose cytarabine (alone or in combination with anthracyclines), has been associated with efficient collection of PBSC in AML, 8,13 whereas fludarabine-based regimens have been less successful.…”