Intensified myeloablative therapy and autologous stem-cell transplantation for patients with AML: single center experience.
BACKGROUND
Thirty-seven consecutive individuals in CR of AML received intensified conditioning and autologous stem-cell transplantation.


METHODS
For those receiving PBSC (n = 28), mobilization protocol was with cyclophosphamide 60 mg/kg followed by G-CSF injection at 5-10 microg/kg; stem cells were harvested by large volume apheresis (6-8 blood volumes) and then cryopreserved. Ablative therapy consisted of fractionated TBI (total 12 Gy), followed by four fractions (1.5 Gy each) of total nodal irradiation (TNI), and CY 120 mg/kg under mesna cover.


RESULTS
For individuals transplanted in CR 1 (n = 31) the median time from diagnosis to grafting was 167 (range 92 - 212) days. Patients transplanted with PBSC received high number of CFU-GM x 10(4)/kg (P < 0.01), a difference that was associated with a significantly shorter platelet recovery. While there was no early transplant-associated mortality, in 10 patients death was caused by recurrence of the disease. The median survival is 1746 (range 105-4467) days and 26 (70%) survive disease free, at a median 2207 (range 698-4467) days from transplantation. Multivariate analysis showed that survival of patients with AML-M3, receiving higher CFU-GM (P = 0.04) and without morphological dysplasia (P = 0.01) was longest.


CONCLUSIONS
For patients in remission of AML, transplantation with PBPC appears to be an effective form of intensification, particularly when TBI + TNI (delivering a total of 18 Gy to the axial skeleton) were used as conditioning.
Novitzky
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N
Department of Haematology, University of Cape Town Medical School, Cape Town, South Africa.
Thomas
V
V
Stubbings
H
H
D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local; D033581:Stem Cell Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D019653:Myeloablative Agonists; D003520:Cyclophosphamide