title: Non-myeloablative hematopoietic stem cell transplantation is of limited value in advanced or refractory acute myeloblastic leukemia. The Mexican experience.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective strategy for preventing relapse of acute myelogenous leukemia (AML). We analyzed the outcome of 31 primary AML patients who received a reduced-intensity conditioning regimen for allogeneic HSCT in first or second remission. Thirty-one AML patients, 20 in first complete remission (FCR), 8 in second complete remission (SCR) and 3 in a partial remission (SPR) were included. All received busulfan 4 mg/kg/d/2 days, fludarabine 30 mg/m(2)/d/3 days and cyclophosphamide 350 mg/m(2)/d/3 days as conditioning regimen. The median number of CD34+ cells infused was 5.6 x 10(6)/kg and 5.2 x 10(6) in FCR and SCR group, respectively. All patients received cyclosporine-A (CsA) and methotrexate as graft vs. host disease (GvHD) prophylaxis. All patients showed myeloid engraftment (neutrophils >0.5 x 10(9)/l) after a median of 13 days in FCR group and 15 days in SCR group. Platelet recovery >20 x 10(9)/l was achieved after a median of 13 days in both groups. Relapse for 20 patients in FCR was 35% compared to 91% for 11 in SCR/SPR (p < 0.05). Conclusions. Reduced-intensity conditioning followed by allogeneic HSCT can induce stable remission in primary AML patients transplanted in FCR. A high relapse rate was documented in patients with refractory or relapsed AML.
authors.affiliation: Servicio de Hematología del Hospital Universitario Dr José E. González, Universidad Autónoma de Nuevo León, Monterrey, NL, México.
authors.forename: C H
authors.initials: CH
authors.lastname: Gutierrez-Aguirre
authors.forename: O G
authors.initials: OG
authors.lastname: Cantú-Rodríguez
authors.forename: O
authors.initials: O
authors.lastname: Gonzalez-Llano
authors.forename: R
authors.initials: R
authors.lastname: Salazar-Riojas
authors.forename: O
authors.initials: O
authors.lastname: Martinez-González
authors.forename: J C
authors.initials: JC
authors.lastname: Jaime-Pérez
authors.forename: A
authors.initials: A
authors.lastname: Morales-Toquero
authors.forename: L C
authors.initials: LC
authors.lastname: Tarín-Arzaga
authors.forename: G J
authors.initials: GJ
authors.lastname: Ruiz-Argüelles
authors.forename: D
authors.initials: D
authors.lastname: Gómez-Almaguer
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008800:Mexico; D008875:Middle Aged; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D016572:Cyclosporine; D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine