Autologous stem cell transplantation for acute myeloid leukemia in first remission.
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.
Linker
C A
CA
University of California, San Francisco, USA. linkerc@medicine.ucsf.edu
Ries
C A
CA
Damon
L E
LE
Sayre
P
P
Navarro
W
W
Rugo
H S
HS
Rubin
A
A
Case
D
D
Crilley
P
P
Topolsky
D
D
Brodsky
I
I
Zamkoff
K
K
Wolfe
J L
JL
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000097:blood / Q000627:therapeutic use / Q000633:toxicity; D002066:Busulfan / Q000008:administration & dosage; D016238:Cytapheresis; D003561:Cytarabine / Q000008:administration & dosage; D003582:Cytogenetics; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D006085:Graft Survival; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007951:Leukemia, Myeloid / Q000628:therapy*; D007958:Leukocyte Count; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D014182:Transplantation, Autologous
D018952:Antigens, CD34; D003561:Cytarabine; D005047:Etoposide; D002066:Busulfan